Perioperative complications of anterior procedures on the spine
Perioperative complications of anterior procedures on the spine
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DOI：
10.2106/00004623-199606000-00006
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发表时间：
1996-06-01
影响因子：
5.3
通讯作者：
Johnson, JR
中科院分区：
文献类型：
--
作者：
McDonnell, MF;Glassman, SD;Johnson, JR
我们回顾了447例患者的手术和住院记录，以确定与胸椎、胸腰椎或腰椎前路手术相关的围手术期并发症的发生率。前路手术用于治疗脊柱畸形或进行椎管清创或减压，我们研究的诊断组包括青少年或年轻人的特发性脊柱侧凸（100例患者），成年人脊柱侧凸（63例患者），脊柱后凸（61例患者），神经肌肉性脊柱侧凸（60例患者），骨折（47例患者），翻修手术（三十九例患者），先天性脊柱侧弯（36例患者），肿瘤（19例患者），脊椎骨髓炎或脊椎炎（8名患者）和其他并发症140例（31%）的447名患者，并被分类为重大或轻微，47名患者（11%）至少有一种重大并发症，109 24%的患者至少有一个轻微并发症，2例患者死于术后肺部并发症，最常见的主要并发症类型是肺部;最常见的轻微并发症类型是泌尿生殖系统，患有特发性脊柱侧凸的青少年或年轻成人患者的并发症发生率最低，患有神经肌肉性脊柱侧凸的患者的并发症发生率最高，手术时年龄超过60岁与并发症的风险较高相关，经胸入路的手术时间短于经胸腰椎或腰椎入路的手术时间;然而，三种方法的并发症发生率没有显著差异，椎骨切除术需要更长的时间来执行，并与更大的估计失血量比椎间盘切除术;然而，两种手术的并发症发生率没有显著差异，骨折或肿瘤患者的失血量高于其他诊断组，所有手术的失血量均随着手术时间的增加而增加，在同一麻醉期内进行前后路联合手术的主要并发症发生率高于在同一麻醉期内进行前后路联合手术的严重并发症发生率。阶段性，逻辑回归分析显示，增加重大并发症风险的变量是估计失血量超过520毫升以及在同一麻醉时间下依次进行前路和后路手术，该分析还表明，青少年或年轻成人的特发性脊柱侧凸诊断与重大并发症风险降低相关，与其他大手术相比，针对本研究中提到的适应症进行的胸椎、胸腰椎或腰椎前路手术相对安全。
We reviewed the operative and hospital records of, 447 patients in order to determine the rates of perioperative complications associated,vith an anterior procedure on the thoracic, thoracolumbar, or lumbar spine, The anterior procedures were performed to treat spinal deformity or for debridement or decompression of the spinal canal, The diagnostic groups that we studied included idiopathic scoliosis in adolescents or young adults (100 patients), scoliosis in mature adults (sixty-three patients), kyphosis (sixty-one patients), neuromuscular scoliosis (sixty patients), fracture (forty-seven patients), a revision procedure (thirty-nine patients), congenital scoliosis (thirty-six patients), tumor (nineteen patients), vertebral osteomyelitis or discitis (eight patients), and miscellaneous (fourteen patients),Complications occurred in 140 (31 per cent) of the 447 patients and were classified as major or minor, Forty-seven patients (11 per cent) had at least one major complication and 109 (24 per cent) had at least one minor complication, Two patients died, both from pulmonary complications after the operation, The most common type of major complication was pulmonary; the most common type of minor complication was genito-urinary, The adolescent or young adult patients who had idiopathic scoliosis had the lowest rate of complications, and the patients who had neuromuscular scoliosis had the highest,An age of more than sixty years at the time of the operation was associated with a higher risk of complications, The duration of the procedures involving a thoracic approach was shorter than that of those involving a thoracolumbar or lumbar approach; however, the rate of complications was not significantly different among the three approaches, Vertebrectomies took longer to perform and were associated with a greater estimated blood loss than discectomies; however, there was no significant difference in the rate of complications between the two types of procedures, The patients who had a fracture or a tumor lost more blood than those from the other diagnostic groups, Blood loss increased as the duration of the operation increased for all procedures, Combined anterior and posterior procedures performed during the same anesthesia session were associated with a higher rate of major complications than were procedures that were staged,A logistical regression analysis showed that the variables that increased the risk of a major complication were an estimated blood loss of more than 520 milliliters and an anterior and posterior procedure performed sequentially under the same anesthesia session, This analysis also demonstrated that the diagnosis of idiopathic scoliosis in adolescents or young adults was associated with a reduced risk of major complications,Compared with other major operations, an anterior procedure on the thoracic, thoracolumbar, or lumbar spine performed for the indications mentioned in this study is relatively safe.