胸腰骶椎结核术后早期并发症的Clavien-Dindo分级评估及其危险因素分析

发布时间：2018-06-27 02:30

本文选题：胸腰骶椎结核 + 术后并发症　；参考：《中国脊柱脊髓杂志》2017年05期

【摘要】：目的 :应用Clavien-Dindo(C-D)并发症分类系统对胸腰骶椎结核术后早期并发症进行评估,并分析其危险因素。方法:回顾性分析2000年1月~2015年12月在我院因脊柱结核行一期病灶清除、椎间植骨内固定术治疗的187例患者临床资料。男112例,女75例;年龄18~85岁,平均45.7±16.0岁。74例有神经功能损害,术前存在合并症29例。病变部位依次为胸椎40例(21.4%)、胸腰段51例(27.3%)、腰椎74例(39.6%)和腰骶椎22例(11.8%)。采用前路手术55例、后路手术98例及前后联合入路手术34例。使用C-D分类系统对患者术后住院期间(≤30d)并发症进行分级评估,先行单因素Logistic回归分析,观察年龄、性别、吸烟史、术前ASIA分级、术前合并症、术前抗结核治疗时间、病变部位、病变范围、术前血红蛋白、术前白蛋白、术前血沉、手术入路、手术时间及术中出血量与并发症的相关性,并对P0.2的变量行多因素Logistic回归分析术后并发症的危险因素。结果:总体并发症发生率为37.4%(70/187),按照C-D并发症分类,Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级和Ⅴ级并发症发生率分别为24.1%、8.0%、2.7%、2.1%和0.5%。单因素Logistic回归分析显示术前合并症、病变范围、术前血红蛋白和术前白蛋白与总体并发症相关,年龄、术前合并症、术前抗结核时间、术前白蛋白和手术时间与Ⅱ级或以上级别并发症相关。多因素Logistic回归分析表明术前白蛋白低为总体并发症的独立危险因素(P=0.034),而术前合并症和手术时间长为Ⅱ级或以上级别并发症的独立危险因素(P=0.024和P=0.015)。结论 :CD并发症分类系统简单、可以提示并发症严重程度,是评估术后并发症的有效方法。术前白蛋白低是胸腰骶椎结核术后早期总体并发症发生的危险因素;术前合并症和手术时间长是脊柱结核术后早期发生C-D分级Ⅱ级或以上级别并发症的危险因素。
[Abstract]:Objective: To evaluate the early complications after the thoracic and lumbosacral tuberculosis with the Clavien-Dindo (C-D) complication classification system and analyze its risk factors. Methods: a retrospective analysis of the clinical data of 187 patients with spinal tuberculosis in our hospital in December, January 2000, with the treatment of spinal tuberculosis and intervertebral fixation, in our hospital, in December, 75 males and 75 women. Cases aged 18~85 years old, the average 45.7 + 16 years old.74 had neurological impairment and there were 29 cases of complication before operation. The lesion site was 40 cases of thoracic vertebra (21.4%), 51 cases in the thoracolumbar (27.3%), 74 lumbar (39.6%) and 22 lumbosacral vertebrae (11.8%). The complications of postoperative hospitalization (less than 30d) were evaluated, and single factor Logistic regression analysis was performed to observe age, sex, smoking history, preoperative ASIA classification, preoperative complication, preoperative anti tuberculosis treatment time, lesion location, lesion range, preoperative hemoglobin, preoperative albumin, preoperative ESR, surgical approach, operation time, and intraoperative bleeding. The correlation between the volume and the complications and the risk factors of postoperative complications after multiple factor Logistic regression analysis of P0.2 variables. Results: the overall incidence of complications was 37.4% (70/187). According to the classification of C-D complications, the incidence of complications of grade I, class II, grade III, grade IV and V was 24.1%, 8%, 2.7%, 2.1%, and 0.5%. single factor Logistic regression, respectively. Analysis showed preoperative complication, lesion range, preoperative hemoglobin and preoperative albumin associated with overall complications, age, preoperative complication, preoperative anti tuberculosis time, preoperative albumin and operation time associated with grade II or above complications. Multivariate Logistic regression analysis showed that preoperative albumin low was independent of the overall complication. Risk factors (P=0.034), an independent risk factor (P=0.024 and P=0.015) for preoperative complication and longer operation time (P=0.024 and P=0.015). Conclusion: the classification system of CD complications is simple and can indicate the severity of complications. It is an effective method for evaluating postoperative complications. The risk factors for the occurrence of body complications; preoperative complication and length of operation are risk factors for the early stage of C-D classification of grade II or above after spinal tuberculosis.
【作者单位】：南方医科大学南方医院脊柱骨科;
【基金】：国家自然科学基金资助项目(编号:81272022)
【分类号】：R687.3

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