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中华骨科杂志
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中华骨科杂志  2016, Vol. 36 Issue (17): 1142-1148    DOI: 10.3760/cma.j.issn.0253-2352.2016.17.009
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胸腰椎骨质疏松性骨折经皮椎体成形术后骨水泥渗漏的研究进展
陈雁华,李娟,陈子贤,周晓岗,董健
355000 福安市,福建医科大学附属闽东医院(陈雁华); 200032 上海,复旦大学 附属中山医院(李娟、陈子贤、周晓岗、董健)
Risk factors analysis of the postoperative complications in spinal tuberculosis patients
Chen Yanhua,Li Juan,Chen Zixian,Zhou Xiaogang,Dong Jian
Department of Orthopaedics, Mindong Hospital, Fujian University, Fu'an 355000, China(Chen YH); Department of Orthopaedics, Zhongshan Hospital, Fudan University, Shanghai 200032, China(LI J, Chen ZX, Zhou XG, Dong J)
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摘要 目的探讨脊柱结核术后并发症的危险因素。方法回顾性分析2005年2月至2013年1月复旦大学附属中山医院骨科行手术治疗172例脊柱结核患者的病历资料,男88例,女84例;年龄18~84岁,平均(50.9±18.7)岁。其中98例伴有冷脓肿,56 例存在结核中毒症状。病灶部位以胸椎(112例,65.1%)和腰椎(40例,23.3%)最为常见,颈椎及骶椎少见。结核累及2个椎间隙最为常见(116例,67.4%),其次为累及多个椎间隙(32例,18.6%),其余则为累及单间隙(24例,14.0%)。38例采用前路手术,54例采用前后路联合手术,80例采用后路手术。58例术前存在不同程度神经损害症状。应用SPSS统计软件包分析住院期间并发症发生情况及相关临床参数,先通过单因素分析各参数与并发症的发生是否相关,再进一步行Logistic多因素回归分析确定手术并发症的可能危险因素。结果172例患者中共有72例(41.9%)发生并发症,其中系统并发症最为常见33.7%(58/172),而局部并发症发生率为10.5%(18/172)。单因素分析结果显示病灶部位、血红蛋白值、电解质紊乱、术后ASIA评分、术中出血量、术前抗结核治疗时间与术后并发症的发生有关,采用后路手术与发生局部并发症相关;多因素回归分析显示术前血红蛋白<100 g/L、术后神经功能较差(ASIA评分)、术前抗结核治疗时间>28 d均与出现术后并发症相关。结论术前贫血(血红蛋白<100 g/L)、术后神经功能差和术前抗结核治疗时间>28 d是发生术后并发症的危险因素。
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陈雁华
李娟
陈子贤
周晓岗
董健
关键词结核   脊柱   脊柱融合术   手术后并发症   危险因素     
Abstract: ObjectiveTo investigate the risk factors of postoperative complications in spinal tuberculosis surgery, and try to find a way to improve the results of perioperative management and reduce or avoid the postoperative complications. MethodsAll of 172 cases of spinal tuberculosis who were treated by surgery from February 2005 to January 2013 in orthopedic department of Zhongshan hospital, Fudan University were retrospectively analyzed. There were 88 males and 84 females, whose average age was 50.9±18.7y (18-84y) . Among them 98 cases got cold abscess, and 56 cases had tuberculosis poisoning symptoms. The lesions located mostly in thoracic spine (112/172, 65.1%) and lumbar spine (40/172, 23.3%), while rarely in cervical or sacral spine. 2 intervertebral spaces were involved in 116 cases (67.4%), more than 2 intervertebral spaces were involved in 32 cases (18.6%), and single intervertebral space were involved in the rest cases (14.0%). 38 cases were treated through single anterior approach, 54 cases were treated by anterior-posterior surgical approach, and single posterior approach was performed in 80 cases. 58 cases were suffered from neurological dysfunction. All the postoperative complications and related clinical parameters during hospitalization period were collected and analyzed with SPSS software. Each clinical parameter was analyzed with univariate analysis to find the factors related to postoperative complications, and then the related factors were analyzed by multivariate regression analysis. ResultsAll of 172 patients were included and 41.9% (72/172) of the patients suffered from postoperative complications. System complications were the most common (33.7%, 58/172). The rates of local complications were 10.5%(18/172). Univariate analysis showed that the lesion site, value of hemoglobin, electrolyte disturbances, postoperative ASIA score and blood loss were related with postoperative complications. Posterior approach related with local complications. Multivariate regression analysis showed that preoperative hemoglobin <100 g/L, poor postoperative ASIA scores and long period of preoperative anti-TB treatment(>28 days)were related with the system or local postoperative complications. ConclusionPatients with anemia (hemoglobin <100g/L), poor postoperative neurological function and long period of preoperative anti-TB treatment could take more risks of the postoperative complications.
Key wordsTuberculosis   spinal   Spinal fusion   Postoperative complications   Risk factors   
收稿日期: 2016-06-06;
作者简介: 董健,E-mail:doctor_dong@126.com
引用本文:   
陈雁华,李娟,陈子贤等. 胸腰椎骨质疏松性骨折经皮椎体成形术后骨水泥渗漏的研究进展[J]. 中华骨科杂志, 2016, 36(17): 1142-1148.
Chen Yanhua,Li Juan,Chen Zixian et al. Risk factors analysis of the postoperative complications in spinal tuberculosis patients[J]. Chin J Orthop, 2016, 36(17): 1142-1148.
链接本文:  
http://www.chinjorthop.com/Jwk_zhgkzz/CN/10.3760/cma.j.issn.0253-2352.2016.17.009      或     http://www.chinjorthop.com/Jwk_zhgkzz/CN/Y2016/V36/I17/1142
 
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