腰椎后路手术后并发深静脉血栓形成的相关因素分析

摘要

目的 研究不同腰椎术式对术后并发深静脉血栓(DVT)产生的不同影响及DVT产生相关因素.方法回顾性研究行腰椎手术患者158例,根据患者行不同腰椎术式患者为4组,球囊扩张椎体成形术组( A组)、椎板切除组(B组)、TLIF单节段融合组(C组)和多节段融合组(融合节段≥3)(D组).所有患者术前1 d、术后1 d、术后1周均进行双侧下肢静脉超声检查,对4组的DVT发生率进行评估,比较4组DVT发生率差异;对DVT发生的相关因素进行Logistic多变量回归分析,探讨危险因素和保护因素;监测患者术后D-二聚体水平,应用ROC曲线评价D-二聚体在腰椎术后DVT诊断中的临床价值.结果 D组在4组中有显著的DVT发生率(P＜0. 05). Logistic回归发现年龄、体重指数,心脑血管合并症、糖尿病、术后长时间卧床、D-二聚体含量增高是DVT产生的危险因素(P＜0. 05),OR值分别为:2. 27、1. 98、1. 68、4. 06、2. 11、9. 62;术后双下肢主被动训练及术后抗血栓药物应用是DVT产生的保护因素(P＜0. 05),OR值分别为:0. 22、0. 11. ROC曲线分析D-二聚体含量≥19. 5 μg/ml为患术后DVT的截断值(cut-off)值.结论 腰椎术后并发深静脉血栓形成的因素众多,重点关注DVT发生的高危人群,并通过相应预防措施防止DVT 的发生,D-二聚体可作为判断术后DVT产生的重要观测指标.%Objective To investigate the influencing factors on deep venous thrombosis (DVT) after lumbar posterior surgery. Methods ?The clinical data about the patients who underwent lumbar posterior surgery in our hospital from June 2014 to January 2017 were retrospectively analyzed. According to different surgical methods,these patients were divided into four groups: balloon catheter extension vertebroplasty group, laminectomy group, TLIF single segment fusion group, TLIF multi segmental fusion group (fusion segment≥3). All the patients underwent bilateral lower limb venous ultrasonography to estimate the incidence of DVT at preoperative 1 day,postoperative 1 day and postoperative 1 week. Multivariate regression analysis was used to analyze the related risk factors and protective factors of DVT,Moreover the D-dimer levels after operation were detected,and its clinical value in diagnosis of DVT after lumbar posterior surgery was evaluated through ROC curve. Results The incidence rate of DVT after lumbar posterior surgery was the highest in TLIF multi segmental fusion group (P＜0. 05). Logistic regression showed that patient's age,body mass index,cardiovascular complications, diabetes,postoperative stay in bed for a long time,he increase of D-dimer levels were the risk factors of DVT (P＜0. 05),however, active and passive exercise in both lower limbs after surgery and application of antithrombotic drugs were the protective factors of DVT formation (P＜0. 05). Moreover ROC curve analysis showed that D-dimer content ≥19. 5μg/ml was the cut-off value of patients with DVT after lumbar posterior surgery. Conclusion The related factors with deep venous thrombosis after lumbar posterior surgery are numerous,it is important to much attention to the high risk population of DVT, and to prevent the incidence of DVT by taking corresponding preventive measures. Moreover D-dimer can be regarded as an important observation index to evaluate the incidence of DVT after lumbar posterior surgery.