Avetisian Henry, Flynn Camille, Banerjee Rakhi, Satish Vivek, Davood Joshua, Karakash William, Gallo Matthew C, Athari Mirbahador, Magee Gregory A, Wang Jeffrey C, Hah Raymond J, Alluri Ram
Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern CA, Los Angeles, CA, USA.
Department of Vascular Surgery, Keck School of Medicine of the University of Southern CA, Los Angeles, CA, USA.
Global Spine J. 2025 Jun 10:21925682251350942. doi: 10.1177/21925682251350942.
Study DesignRetrospective cohort study.ObjectivesTo evaluate the incidence, risk factors, and complications associated with intraoperative venous injury during anterior lumbar interbody fusion (ALIF).MethodsThis retrospective review included patients who underwent one- to four-level ALIF at an academic spine center. Patients <18 years old or those with surgical indications for trauma, infection, or malignancy were excluded. Patients were stratified by the presence of venous laceration requiring primary suture repair. Comparative analyses were performed using Student's test and Pearson's Chi-squared test. Univariable and multivariable logistic regression identified independent risk factors and postoperative complications.ResultsAmong 554 patients, 92 (16.61%) sustained a venous laceration. Independent predictors included age (aOR: 1.03, < 0.01), chronic kidney disease (aOR: 5.17, < 0.01), ALIF at L4-5 (aOR: 3.88, < 0.01), and two-level ALIF (aOR: 1.70, < 0.01). ALIF at L5-S1 was protective (aOR: 0.24, < 0.001). Venous laceration was associated with longer operative times (8.02 ± 2.95 vs 6.48 ± 2.81 hours, < 0.001), greater mean blood loss (1,271 mL vs 600.71 mL, < 0.001), and increased risks of deep vein thrombosis (DVT) (aOR: 3.33, [1.59-10.17], = 0.011), intraoperative transfusion (aOR: 4.43, < 0.001), and incision and drainage (aOR: 7.45, [1.75-31.62], < 0.01).ConclusionVenous laceration occurred in 16.61% of ALIF cases, with independent risk factors including age, CKD, L4-5 ALIF, and two-level ALIF. These injuries were associated with prolonged operative times and a markedly elevated risk of DVT. Future research should focus on developing risk reduction strategies for high-risk patients and developing evidence-based VTE prophylaxis protocols tailored to patients with venous injuries.
研究设计
回顾性队列研究。
目的
评估腰椎前路椎间融合术（ALIF）术中静脉损伤的发生率、危险因素及并发症。
方法
这项回顾性研究纳入了在一家学术性脊柱中心接受一至四级ALIF手术的患者。排除年龄<18岁或有创伤、感染或恶性肿瘤手术指征的患者。根据是否存在需要一期缝合修复的静脉撕裂进行分层。采用学生t检验和Pearson卡方检验进行比较分析。单变量和多变量逻辑回归确定独立危险因素和术后并发症。
结果
在554例患者中，92例（16.61%）发生静脉撕裂。独立预测因素包括年龄（调整后比值比[aOR]：1.03，P<0.01）、慢性肾脏病（aOR：5.17，P<0.01）、L4-5节段的ALIF（aOR：3.88，P<0.01）以及二级ALIF（aOR：1.70，P<0.01）。L5-S1节段的ALIF具有保护作用（aOR：0.24，P<0.001）。静脉撕裂与手术时间延长相关（8.02±2.95小时 vs 6.48±2.81小时，P<0.001）、平均失血量增加（1271 mL vs 600.71 mL，P<0.001）以及深静脉血栓形成（DVT）风险增加（aOR：3.33，[1.59-10.17]，P=0.011）、术中输血风险增加（aOR：4.43，P<0.001）和切开引流风险增加（aOR：7.45，[1.75-31.62]，P<0.01）。
结论
16.61%的ALIF病例发生静脉撕裂，独立危险因素包括年龄、慢性肾脏病、L4-5节段的ALIF和二级ALIF。这些损伤与手术时间延长以及DVT风险显著升高相关。未来的研究应侧重于为高危患者制定降低风险策略，并制定针对静脉损伤患者的循证VTE预防方案。
