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单侧双通道内镜手术治疗腰椎管狭窄症隐性失血的危险因素。

Risk Factors of Hidden Blood Loss in Unilateral Biportal Endoscopic Surgery for Patients with Lumbar Spinal Stenosis.

机构信息

Department of Foot and Ankle Surgery, Xiangyang Hospital of Traditional Chinese Medicine (The Affiliated Orthopedics & Traumatology Hospital of Hubei University of Traditional Chinese Medicine), Xiangyang, China.

Department of Spine Surgery, Orthopedic Hospital of Mianyang City, Mianyang, China.

出版信息

Orthop Surg. 2024 Apr;16(4):842-850. doi: 10.1111/os.14009. Epub 2024 Feb 21.

DOI:10.1111/os.14009
PMID:38384164
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10984805/
Abstract

OBJECTIVE: Unilateral biportal endoscopic (UBE) surgery has recently been used as a minimally invasive procedure for the treatment of lumbar spinal stenosis and is associated with less perioperative blood loss. However, perioperative hidden blood loss (HBL) may be neglected during UBE. This study aimed to examine the volume of HBL and discuss the influential risk factors for HBL during unilateral biportal endoscopic surgery. METHODS: From January 2022 to August 2022, 51 patients underwent percutaneous unilateral biportal endoscopic surgery for lumbar spinal stenosis at the Department of Spinal Surgery of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University and were enrolled in this study. The data included general indicators (age, sex and body mass index [BMI]), underlying disease (hypertension and diabetes), laboratory test results (prothrombin time [PT], activated partial thromboplastin time [APTT], fibrinogen [Fbg]), and preoperative and postoperative hematocrit and hemoglobin), related imaging parameters (severity of intervertebral disc [IVD] degeneration and soft tissue thickness of the interlaminar approach), number of operated vertebrae and operation time. Total blood loss (TBL) and HBL during surgical procedures were measured via the Gross formula. Influential factors were further analyzed by multivariate linear regression analysis and t-tests. RESULTS: The mean HBL was 257.89 ± 190.66 mL for single-operation patients and 296.58 ± 269.75 mL for two-operation patients. Patients with lower PT (p = 0.044), deeper tissue thickness (p = 0.047), and diabetes mellitus were determined to have more HBL during UBE. The operation time might also be an important factor (p = 0.047). However, sex (p = 0.265), age (p = 0.771/0.624), BMI (p = 0.655/0.664), APTT (p = 0.545/0.751), degree of degenerated IVD (p = 0.932/0.477), and hypertension (p = 0.356/0.896) were not related to HBL. CONCLUSION: This study determined the different influential factors of HBL during UBE. PT, tissue thickness, and diabetes mellitus are the independent risk factors that affect HBL incidence. Long PT may decrease the volume of HBL within a certain range. Tissue thickness and diabetes mellitus can lead to an increased volume of HBL.

摘要

目的：单侧双通道内镜（UBE）手术最近已被用作治疗腰椎管狭窄症的微创手术，其围手术期失血量较少。然而，UBE 术中可能会忽略围手术期隐性失血（HBL）。本研究旨在探讨单侧双通道内镜手术中 HBL 的量，并探讨 HBL 的影响因素。

方法：2022 年 1 月至 2022 年 8 月，西南医科大学附属中医院脊柱外科采用经皮单侧双通道内镜手术治疗腰椎管狭窄症 51 例，纳入本研究。资料包括一般指标（年龄、性别、体重指数）[BMI]）、基础疾病（高血压、糖尿病）、实验室检查结果（凝血酶原时间[PT]、活化部分凝血活酶时间[APTT]、纤维蛋白原[Fbg]）、术前及术后红细胞压积和血红蛋白）、相关影像学参数（椎间盘[IVD]退变严重程度、椎间孔入路软组织厚度）、手术节段数和手术时间。通过 Gross 公式测量手术过程中的总失血量（TBL）和 HBL。采用多元线性回归分析和 t 检验进一步分析影响因素。

结果：单操作患者的平均 HBL 为 257.89±190.66mL，双操作患者的平均 HBL 为 296.58±269.75mL。PT 较低（p=0.044）、组织厚度较深（p=0.047）、糖尿病患者的 UBE 术中 HBL 较多。手术时间也可能是一个重要因素（p=0.047）。然而，性别（p=0.265）、年龄（p=0.771/0.624）、BMI（p=0.655/0.664）、APTT（p=0.545/0.751）、退变 IVD 程度（p=0.932/0.477）和高血压（p=0.356/0.896）与 HBL 无关。

结论：本研究确定了 UBE 术中 HBL 的不同影响因素。PT、组织厚度和糖尿病是影响 HBL 发生率的独立危险因素。较长的 PT 可能会在一定范围内降低 HBL 的量。组织厚度和糖尿病会导致 HBL 量增加。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f9/10984805/c6d9e46a4db7/OS-16-842-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f9/10984805/f86c9050d85f/OS-16-842-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f9/10984805/c7a250691f2a/OS-16-842-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f9/10984805/c6d9e46a4db7/OS-16-842-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f9/10984805/f86c9050d85f/OS-16-842-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f9/10984805/c7a250691f2a/OS-16-842-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f9/10984805/c6d9e46a4db7/OS-16-842-g003.jpg

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引用本文的文献

[1]
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Orthop Surg. 2025-9

[2]
Comparison of perioperative blood loss of three different posterior nonfusion decompression operations for single-segment lumbar disc herniation.

Front Neurol. 2025-6-18

[3]
Comparison of Hidden Blood Loss in Biportal Endoscopic Spine Surgery and Open Surgery in the Lumbar Spine: A Retrospective Multicenter Study.

J Clin Med. 2025-5-30

[4]
Unilateral biportal endoscopic in spine surgery: a global bibliometric analysis of research trends and influences.

Eur Spine J. 2025-6-7

[5]
Efficacy and Safety of Tranexamic Acid on Hidden Blood Loss in Osteoporotic Vertebral Compression Fractures Patients Treated with Percutaneous Kyphoplasty: A Prospective Randomized Controlled Trial.

Ther Clin Risk Manag. 2024-12-25

[6]
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Jt Dis Relat Surg. 2025-1-2

[7]
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Cureus. 2024-12-1

[8]
Comparison of surgical invasiveness and hidden blood loss between unilateral double portal endoscopic lumbar disc extraction and percutaneous endoscopic interlaminar discectomy for lumbar spinal stenosis.

J Orthop Surg Res. 2024-11-21

[9]
Supplementary decompression and extended surgical time contribute to hidden blood loss In percutaneous endoscopic lumbar discectomy.

Heliyon. 2024-6-22

本文引用的文献

[1]
Exploring Physical Lumbar Microvascular Geometry Through Endoscopy and Illustrations: Implications for Clinical Interpretation.

Global Spine J. 2025-3

[2]
Prehospital Tranexamic Acid for Severe Trauma.

N Engl J Med. 2023-7-13

[3]
Substantially High Hidden Blood Loss in Oblique Lateral Interbody Fusion: Retrospective Case Series.

Medicina (Kaunas). 2022-4-9

[4]
Tranexamic acid safely reduces hidden blood loss in patients undergoing intertrochanteric fracture surgery: a randomized controlled trial.

Eur J Trauma Emerg Surg. 2022-4

[5]
Tranexamic acid reduce hidden blood loss in posterior lumbar interbody fusion (PLIF) surgery.

Medicine (Baltimore). 2020-3

[6]
Percutaneous Unilateral Biportal Endoscopic Spine Surgery Using a 30-Degree Arthroscope in Patients With Severe Lumbar Spinal Stenosis: A Technical Note.

Clin Spine Surg. 2019-10

[7]
Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery.

Neurosurg Focus. 2019-5-1

[8]
Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis.

Asian Spine J. 2019-4

[9]
Bilateral decompression and intervertebral fusion via unilateral fenestration for complex lumbar spinal stenosis with a mobile microendoscopic technique.

Medicine (Baltimore). 2018-1

[10]
Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion.

J Orthop Traumatol. 2017-12

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