颈椎手术患者术后发生硬膜外血肿危险因素的Meta分析

【摘要】 目的：系统评价颈椎手术患者术后发生硬膜外血肿的相关危险因素。方法：通过计算机检索PubMed、Embase、the Cochrane Library、Web of Science、中国知网（CNKI）、万方数据库（Wanfang）、维普数据库（VIP）和中国生物医学文献数据库（CBM）,自建库至2023年4月公开发表的有关颈椎手术患者术后发生硬膜外血肿的回顾性或前瞻性研究,2名评价者分别按照纳入与排除标准对所获文献进行文献筛选,采用NOS量表进行质量评价,提纳取入文献的基本信息,包括年龄、性别及体质指数（body mass index,BMI）以及与颈椎术后硬膜外血肿发生相关研究因素（如手术节段、是否合并后纵韧带骨化、手术时间、糖尿病史、高血压病史、吸烟史、非甾体抗炎药的使用以及实验室相关指标等）,通过RevMan 5.4软件进行Meta分析。采用漏斗图对纳入的研究进行偏倚风险分析。结果：共纳入12篇文献,纳入文献的NOS质量评分均在6~8分,其中11篇为高质量研究,1篇为中质量研究。Meta分析显示：男性[比值比（odds ratio,OR）=2.84,95%可信区间（confidence interval,CI）（1.73,4.67）,P＜0.0001]、BMI＞24kg/m2[OR=8.50,95%CI（2.56,25.24）,P=0.0005]、多手术节段（手术节段≥2）[OR=2.26,95%CI（1.42,3.59）,P=0.0005]、手术时长＞2h[OR=1.46,95%CI（1.08,1.97）,P＝0.01]、术前服用非甾体类抗炎药物[OR=3.60,95%CI（1.00,12.99）,P=0.05]是颈椎术后发生硬膜外血肿的危险因素。采用漏斗图对纳入文献最多的影响因素手术节段及术中出血量进行发表偏倚检验结果显示手术节段不存在发表偏倚,而术后出血量存在部分发表偏倚。结论：男性、BMI过大、多节段手术、手术时间长、术前服用非甾体类抗炎类药物等是颈椎术后SEH发生的危险因素。     

腰椎术后硬膜外血肿的危险因素和临床转归

目的 :探讨腰椎手术后硬膜外血肿形成的危险因素,并随访血肿清除术后患者神经功能恢复情况。方法:2009年1月~2014年1月在北京医院骨科因腰椎管狭窄症或腰椎间盘突出症行腰椎后路减压椎弓根螺钉内固定术的患者共1225例,术后发生硬膜外血肿致马尾神经功能受损的患者共8例,收集和整理血肿患者的一般资料,并对其血肿清除手术后神经功能恢复情况进行随访。采取病例对照研究的方法,按照每1例腰椎术后硬膜外血肿患者随机选取3例诊断、手术方式及手术医师均相同的24例患者作为对照。对两组患者的年龄、性别、高血压病史、糖尿病病史、非甾体类镇痛药物应用、抗血小板聚集药物的应用、是否为翻修手术,及手术融合节段数、手术时间、术中失血量、输红细胞悬液量、是否输注了冰冻血浆进行多元回归分析,采用多元Logistic回归模型确定每个因素是否为硬膜外血肿形成可能的危险因素,计算其OR(Odd′s Ratio)值。结果 :多元Logistic回归模型回归分析结果显示,手术前危险因素是年龄65岁和翻修手术,手术中危险因素是手术时间120min、失血量600ml、手术中输注了冰冻血浆。血肿清除术后神经功能完全恢复者2例,部分恢复者4例,无恢复者2例。结论:患者年龄65岁、翻修手术、手术时间120min、术中出血量600ml、术中输注冰冻血浆是腰椎手术后硬膜外血肿形成的危险因素;血肿清除术后大部分患者神经功能得到不同程度恢复。     

脊柱减压术后症状性硬膜外血肿形成的影响因素分析

目的 探讨脊柱减压术后症状性硬膜外血肿(spinal symptomatic epidural hematoma,SSEH)形成的危险因素,为脊柱术后症状性硬膜外血肿的预防及治疗提供依据.方法 纳入2010年1月～2020年1月在本院行脊柱后路减压手术后发生SSEH的20例患者,设为血肿组;同时采用随机数表法按1:4比例选择未发生SSEH的患者80例,设为正常组.收集两组患者的病例资料,采用单因素和多因素回归分析确定脊柱减压术后SSEH的独立危险因素.结果 两组患者的年龄、术前抗血小板药物使用、术前术后收缩压波动值(△SBP)、长期吸烟史、术中出血量、手术时间、明胶海绵的使用、非正常拔管、术后引流量等指标有统计学差异(P<0.05);Logistic回归分析显示:血清钙值<2.03 mmol/L(OR=4.846)、△SBP>20 mmHg(OR=2.935)、手术时间>3 h(OR=13.00)、术中出血量>250 mL(OR=4.529)、明胶海绵的使用(OR=5.412)是脊柱减压术后SSEH形成的独立危险因素.结论 脊柱减压术后症状性硬膜外血肿形成的独立危险因素是血清钙值<2.03 mmol/L、△SBP>20 mmHg、手术时间>3 h、术中出血量>250 mL、明胶海绵的使用.     

颈椎后路手术后有症状硬膜外血肿及其危险因素

目的 :探讨颈椎后路手术后有症状硬膜外血肿(symptomatic epidural hematoma,SEH)的发生情况及危险因素,为预防硬膜外血肿提供依据及处理措施。方法:回顾性分析2012年9月~2017年9月在我院接受颈椎后路椎管扩大椎板成形术或椎板切除术的患者(除外骨折、脱位、感染及肿瘤),找出术后发生SEH的患者(SEH组),并从相同时间段内未发生SEH的患者中按照1∶4的比例随机抽取对照组,收集患者性别、年龄、体重指数BMI、是否合并后纵韧带骨化(ossification of posterior longitudinal ligament,OPLL)、有无外伤、是否合并高血压、糖尿病或动脉粥样硬化性疾病、是否服用抗血小板药物、血小板计数、凝血酶原时间(PT)、部分凝血酶原活化时间(APTT)、国际标准比值(INR)、血清总蛋白、白蛋白、血钙、手术节段数、内固定节段数、是否行椎板切除、手术时间及术中失血量等可能对SEH发生有影响的因素。应用t检验、卡方检验以及多因素Logistic回归分析,分析其与SEH发生的相关性。结果:共有3859例患者接受颈椎后路手术,其中19例患者术后发生SEH,发生率为0.49%。术后出现血肿中位时间为120min(30min~15d)。2例患者以躯体或四肢麻木为首发症状,17例患者首要表现为四肢肌力明显下降,后随时间推移,所有患者均出现肌力下降,神经功能Frankel分级B级4例,C级13例,D级2例。出现临床症状后,7例患者接受MRI检查,明确诊断为SEH,另12例患者通过临床症状确诊。19例均接受急诊手术探查、硬膜外血肿清除术。术后患者肌力均有恢复,所有患者经血肿清除术后神经功能Frankel分级均恢复至少1级。两组比较,合并OPLL比例、手术节段数、内固定长度、手术时间、术中出血量等有显著性差异(P0.05);多因素Logistic回归分析显示,手术节段数和合并OPLL与术后SEH的发生具有显著相关性(P0.05)。结论:手术节段数以及合并OPLL是颈椎后路手术后发生SEH的危险因素,对于有相关危险因素的患者术后应密切观察神经功能,保证引流通畅。     

腰椎术后硬膜外血肿的诊治分析

目的探讨腰椎术后硬膜外血肿的病因、诊断、治疗及其鉴别诊断。方法自1998-07-2011-05对我院诊治的11例腰椎术后硬膜外血肿症的病因、诊断、手术治疗结果进行了回顾性分析。结果术后随访12~36月,平均20月,术后患者神经功能明显改善。经Spearman等级相关分析,从出现硬膜外血肿神经受损的症状至手术探查的时间间隔与术前ASIA等级呈负相关(Rs=-0.698,P<0.05),Speanman等级相关系数具有统计学意义。结论患者的临床症状及体征是诊断腰椎术后硬膜外血肿的主要依据,早期诊断及手术治疗是取得良好治疗效果的关键。     

腰椎术后硬膜外血肿的早期诊断治疗

目的 探讨腰椎后手术后因引流不畅、引流管阻塞导致硬膜外血肿形成的诊断及治疗.方法 对腰椎后路术后4例出现硬膜外血肿的患者进行临床分析.结果 4例患者均在腰椎后路手术后进行伤口探查、血肿清除、脊髓减压术,术后神经系统症状均有恢复.结论 对于腰椎后路手术后硬膜外血肿形成,早期手术治疗对神经障碍恢复的效果与手术减压时间及神...     

经椎间孔入路腰椎内镜术后症状性血肿3例

<正>病例1:男,67岁。因右下肢放射性疼痛,行走受限8个月余入院,既往有冠心病史8年,长期口服阿司匹林片,每日1次,每次100 mg;曾行腰椎保守治疗3个月余未见缓解。查体:右臀部、右大腿后侧、小腿前外侧、足背皮肤痛觉减退,右拇背伸肌力Ⅳ级,右直腿抬高试验20°阳性。腰椎MRI和CT示L_4,5椎间盘突出合并右侧神经根管狭窄。     

腰椎退行性疾病手术患者腰椎术后综合征发生情况及危险因素分析

目的研究腰椎退行性疾病手术患者的腰椎术后综合征(failed back surgery syndrome,FBSS)发生情况,并分析其危险因素。方法纳入2015年1月～2017年6月手术治疗的176例腰椎退行性疾病患者,术后随访1年以上,依据FBSS发生情况,设为FBSS组与非FBSS组。收集两组患者病历资料,组间经单因素分析和多因素Logistic回归分析调查术后发生FBSS的独立危险因素。结果 176例患者发生FBSS 40例,发生率为22.73%;两组瘢痕体质、术后关节突关节间隙增大、合并骨质疏松、手术术式、首次锻炼时间、合并糖尿病、性别、年龄、术中出血量、病程的差异均有统计学意义(P0.05);多因素Logistic回归分析显示,瘢痕体质(OR=3.213)、术后关节突关节间隙增大(OR=3.032)、合并骨质疏松(OR=2.764)、开放性手术(OR=2.486)、首次锻炼时间3 d(OR=3.331)、合并糖尿病(OR=2.343),均是术后并发FBSS的独立危险因素。结论腰椎退行性疾病手术患者FBSS的发生率较高,瘢痕体质、术后关节突关节间隙增大、合并骨质疏松、开放性手术、首次锻炼时间3 d、合并糖尿病均会增加其发生风险。     

腰椎后路减压内固定术后发生硬膜外血肿形成的影响因素分析

目的研究腰椎后路减压内固定术后发生硬膜外血肿(spinal epidural hematomas,SEH)形成的影响因素,为SEH防治方案的建立提供理论依据。方法纳入10例行腰椎后路减压内固定术后发生SHE的患者,将之设为观察组,按1:3比例选择30例未发生SEH的匹配患者设为对照组。分析所有患者病历资料,比较性别、年龄以及合并疾病等,采用单因素、多因素分析确定术后发生SEH的危险因素。结果单因素分析显示,两组合并糖尿病、抗血小板(PLT)、翻修手术、手术时间、术中失血量、冰冻血液输入、凝血酶原时间、年龄的差异具有统计学意义(P0.05);多因素logistic回归分析结果显示,翻修手术、出血量600 ml、年龄65岁、冰冻血液输入、手术时间120 min,均是腰椎后路减压内固定术后发生SEH的独立危险因素。结论腰椎后路减压内固定术后SEH发生率较低,翻修手术、出血量600 ml、年龄65岁、冰冻血液输入、手术时间120 min会增加腰椎后路减压内固定术后SHE的发生风险。     

腰椎椎体间融合术后cage后移危险因素的Meta分析

【摘要】 目的：通过系统评价的方法分析影响腰椎椎体间融合术后cage后移（cage retropulsion,CR）发生的危险因素。方法：检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库（CBM）、中国知网（CNKI）、万方数据库和维普数据库,收集各数据库建库至2023年4月有关影响腰椎椎体间融合术后CR危险因素的文献,研究类型为队列研究及病例对照研究,采用纽卡斯尔-渥太华质量评估量表（Newcastle-Ottawa scale,NOS）对纳入研究进行质量评价,提取纳入研究的基本信息,包括年龄及性别等以及CR发生相关研究因素,如骨质疏松、终板损伤、螺钉松动、梨形椎间隙、cage形状、cage置入深度及手术时长、出血量等。评价纳入研究的偏倚风险后,使用Stata14.0软件进行Meta分析。结果：共纳入16篇相关文献,其中15篇文献为回顾性病例对照研究,1篇为前瞻性队列研究,均为中等及以上质量研究,NOS评分均≥7分。总样本量12667例,其中发生CR者（CR组）326例,未发生CR者（nCR组）12341例,CR发生率为2.83%。Meta分析结果显示：性别（男性）[比值比（odds ratio,OR）=1.264,95%置信区间（confidence interval,CI）（1.003～1.593）,P=0.047]、年龄[效应量标准化平均差（standardized mean difference,SMD）=0.237,95%CI（0.054～0.419）,P=0.011]、骨质疏松[OR=3.126,95%CI（1.040～9.401）,P=0.042]、骨终板损伤[OR=8.161,95%CI（3.711～17.945）,P=0.000]、螺钉松动[OR=7.978,95%CI（3.487～18.255）,P=0.000]、梨形椎间隙[OR=6.037,95%CI（2.381～15.305）,P=0.000]、cage置入深度不足[OR=5.157,95%CI（1.760～15.111）,P=0.003]是腰椎椎体间融合术后发生CR的危险因素。结论：性别（男性）、高龄、骨质疏松、骨终板损伤、螺钉松动、梨形椎间隙、cage置入深度不足与腰椎椎体间融合术后发生CR密切相关,随访期间应对此类患者密切观察,预防发生严重cage移位的并发症。     

Risk factors of postoperative spinal epidural hematoma after transforaminal lumbar interbody fusion surgery

ObjectTo assess the incidence and analyze the risk factors of postoperative spinal epidural hematoma (SEH) after transforaminal lumbar interbody fusion (TLIF) surgery, in order to provide a solution for reducing the occurrence of postoperative SEH after TLIF.MethodsA total of 3717 patients who were performed TLIF surgery in the Orthopedics department of our hospital from January 2010 to March 2020 were included. Patients who had reoperations due to postoperative SEH were selected as the SEH group. The control group was randomly selected from patients without reoperations with the ratio of 3:1 compared to the SEH group. The basic information, preoperative examination and surgical information of the patients were collected through the hospital medical record system, and the statistics were processed through SPSS 22.0 software.Results(1) Among the 3717 patients who underwent TLIF surgery in our hospital in the past 10 years, 46 had secondary surgeries, with a total incidence of 1.24%. 12 cases had secondary surgeries due to postoperative SEH, with an incidence of 0.35%. (2) Univariate analysis identified eight factors potentially associated with risk for postoperative SEH, including older age, longer thrombin time (TT), higher level of alkaline phosphatase (ALP), higher number of fusion segments, revision surgery, having received blood transfusion, using of more than one gelatin sponge or using of styptic powder in the surgery, longer operation time and more blood loss in the surgery (P < 0.05). (3) On multivariate analysis, three factors were identified as independent risk factors, which include revision surgery (P = 0.021, OR = 7.667), longer TT (P = 0.027, OR = 2.586) and using of more than one gelatin sponge or using of styptic powder in the surgery (P = 0.012, OR = 9.000).ConclusionsRevision surgery (P = 0.021, OR = 7.667), longer TT (P = 0.027, OR = 2.586) and using of more than one gelatin sponge or using of styptic powder in the surgery were independent risk factors for postoperative SEH after TLIF.     

Idiopathic symptomatic epidural lipomatosis of the lumbar spine

Summary.  Background: Symptomatic spinal epidural lipomatosis (SEL) of the lumbar spine is a rare disease, often associated with steroid overload. Idiopathic lipomatosis is even much less frequent. Signs and symptoms depend upon the level and degree of nerve root compression. Diagnosis is best based on MRI. Weight reduction can be curative, however after failure of medical treatment or in severe cases surgical decompression should be performed.  Method: Four patients with severe symptoms of lumbar spinal epidural lipomatosis were treated by surgical decompression. Patient history and neurological examination are described, diagnostic imaging is demonstrated, surgical treatment and outcome are documented. Different surgical techniques including laminectomy, interlaminar fenestration and lateral recess decompression were applied and are discussed.  Findings: All four patients improved after surgery. No surgical complications were observed. Even though limited to four cases this is the second largest series of operated idiopathic spinal epidural lipomatosis.  Interpretation: Surgical decompression was effective in improving symptoms in severe lumbar idiopathic spinal epidural lipomatosis. Published online April 28, 2003  Correspondence: M. Payer, M.D., Hiltbrunnerweg 10, 8713 Uerikon, Switzerland.     

Functional results and the risk factors of reoperations after lumbar disc surgery

Factors such as driving motor vehicles, sedentary occupations, vibration, smoking, previous full-term pregnancies, physical inactivity, increased body mass index (BMI), and a tall stature are associated with symptomatic disc herniations. Fitness and strength is postulated to protect an individual from disc rupture. The objective of our study was to determine the pain levels and differences of functional and economic situations of patients who had undergone one or more than one operation due to lumbar disc herniation and to put forward the effect of risk factors that may be potential, especially from the aspect of undergoing reoperation. Patients who had undergone one (n=46) or more than one operation (n=34) due to lumbar disc herniation were included in the study. It was a prospective study with evaluation on the day the patients were discharged and at second and sixth months after lumbar disc operation. The Oswestry Disability Index (ODI) was used in determining the functional disability associated with back pain; the Prolo Functional Economic Rating Scale (Prolo scale) was used in determining the effect of back pain on functional and economic situations. In the ODI measurements made in the postoperative second and sixth months, significant differences appeared in favor of patients who had undergone one operation (p<0.05). According to the Prolo scale, it was found that the economic situation was better in the sixth month and the functional situation was better in the second and sixth months in patients having undergone one operation (p<0.05). The logistic regression analysis demonstrated that the lack of regular physical exercise was a significant predictor for reoperation (OR, 4.595; CI, 1.38–15.28), whereas gender, age, BMI, occupation, or smoking did not indicate so much significance as regular exercise.     

Chronic spontaneous spinal epidural hematoma simulating a lumbar stenosis

Summary A case of a patient with a clinical picture of lumbar spine stenosis actually caused by a chronic, spontaneous, spinal epidural hematoma is reported. There was no history of major or minor trauma to the lumbar spine. The correct preoperative diagnosis was made by magnetic resonance imaging. The possible etiology and clinical and radiological findings and treatment of this rare entity are discussed.     

Post-traumatic cervical spine epidural hematoma: Incidence and risk factors

BackgroundThe incidence and risk factors for post-traumatic cervical epidural hematoma are not well described in the current literature. Our aim was to determine the incidence and associated risk factors for post-traumatic cervical spine epidural hematoma (SEH).MethodsWe performed a retrospective review of our institution’s prospectively collected data submitted to the state trauma registry, using ICD-9 codes, for all patients activated as a trauma with cervical spine injuries, between the years 2010 and 2014. Patients with MRI available were classified based on the presence of cervical epidural hematoma (CEH) or no hematoma (NEH). For our second analysis, we classified patients with cord compression associated with an epidural hematoma (CC) and no cord compression (NCC). Potential risk factors evaluated included: INR, PTT, albumin and platelets levels, radiographic findings of Ankylosing Spondylitis (AS), and ISS. No conflicts of interest exist and/or funding was used for this study.Results497 out of 1810 trauma activations met our inclusion criteria. 46 patients (2.5%) were found to have a post-traumatic cervical SEH (CEH). Of the CEH cohort, 76% were male, with 72% Caucasian, and a mean age of 55 years. 27 patients (5.4%) were found to have cervical cord compression at the level of the SEH. Of the CC arm, 78% were male, with 67% Caucasian, and a mean age of 56 years. A higher ISS and an elevated INR were found to be associated with epidural hematoma causing cord compression.ConclusionsAn incidence of 2.5% is reported for post-traumatic cervical spine epidural hematoma. Of these, 59% had associated spinal cord compression. Patients with a higher ISS and elevated INR levels are at a higher risk for developing this potentially devastating.