脊柱手术医源性脊髓损伤的相关因素回顾性分析及预防措施

摘要

To study the risk factors related to iatrogenic spinal cord injury occurred in the process of spinal surgery, and put forward prevention measures, so as to provide a certain reference for reducing the incidecne of iatrogenic spinal cord in-jury in clinical practice. Methods 58 patients with iatrogenic spinal cord injury in spinal surgery were selected as the spinal cord injury group, and 174 patients without iatrogenic spinal cord injury in spinal surgery were randomly selected as the non-spinal cord injury group according to the ratio of 1:3. The relative risk factors that may cause spinal cord injury were analyzed retro-spectively. Results The incidence of iatrogenic spinal cord injury occurred in spine surgery in our hospital is 0.66%; High blood pressure, diabetes, preoperative traction, spinal canal protrusions and epidural adhesion, intraoperative use of a bipolar electric condenser, spinal canal using bone wax or gelatin sponge, segmental artery ligation or embolism, three-dimensional orthopedic op-eration, intraoperative use of methyl prednisolone comparing the differences between two groups have statistical significance ( P<0.05); The results of multiariable logistic regression analysis show that with high blood pressure, diabetes mellitus, intraoperative use of a bipolar electric condenser, spinal canal using bone wax or gelatin sponge, segmental artery ligation or embolism, three-di-mensional orthopedic operation are the risk factors causing iatrogenic spinal cord injury (P<0.05), preoperative traction, intraopera-tive use of methyl prednisolone are the protective factors for reducing iatrogenic spinal cord injury (P<0.05). Conclusion Many factors can cause the spinal cord injury in the process of spinal surgery, so risk factors should be avoided and protective factors should be taken in order to reduce the incidence of iatrogenic spinal cord injury.%探讨脊柱手术过程中发生医源性脊髓损伤的相关危险因素，并提出预防措施，以期能为临床减少医源性脊髓损伤的发生提供一定的参考。方法以脊柱手术发生医源性脊髓损伤的58例患者为脊髓损伤组，以1：3的比例随机抽取脊柱手术未发生医源性脊髓损伤的174例患者为无脊髓脊髓组，回顾性分析可能引起脊髓损伤的相关危险因素。结果该院脊柱手术医源性脊髓损伤发生率为0.66%；高血压、糖尿病、术前牵引、椎管内突出物与硬膜粘连、术中使用双极电凝器、椎管内使用骨蜡或明胶海绵、结扎或栓塞节段动脉、三维矫形操作、术中使用甲基强的松龙两组之间比较差异有统计学意义（P<0.05）；多因素Logistic回归分析结果显示合并有高血压、合并糖尿病、术中使用双极电凝器、椎管内使用骨蜡或明胶海绵、结扎或栓塞节段动脉、三维矫形操作是引起患者患者发生医源性脊髓损伤的危险因素差异有统计学意义（P<0.05），术前牵引、术中使用甲基强的松龙是降低医源性脊髓损伤的保护因素差异有统计学意义（P<0.05）。结论脊柱手术过程影响脊髓损伤发生的因素较多，应避免危险因素采取保护因素以减少医源性脊髓损伤的发生。