Object

To 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.

Methods

A 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).

Conclusions

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 were independent risk factors for postoperative SEH after TLIF.

中文翻译：

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经椎间孔腰椎椎间融合手术后硬膜外血肿的危险因素

目的

评估经椎间孔腰椎椎间融合术（TLIF）术后硬膜外血肿（SEH）的发生率并分析其危险因素，为减少TLIF术后SEH的发生提供解决方案。

方法

共纳入2010年1月至2020年3月在我院骨科进行TLIF手术的患者3717例。选择因术后 SEH 而再次手术的患者作为 SEH 组。对照组随机选择未再次手术的患者，与SEH组的比例为3：1。通过医院病历系统收集患者的基本信息、术前检查和手术信息，通过SPSS 22.0软件进行统计处理。

结果

(1)我院近10年来接受TLIF手术的3717例患者中，46例进行了二次手术，总发生率为1.24%。术后SEH再次手术12例，发生率为0.35%。(2) 单变量分析确定了 8 个可能与术后 SEH 风险相关的因素，包括年龄较大、凝血酶时间 (TT) 较长、碱性磷酸酶 (ALP) 水平较高、融合节段数量较多、翻修手术、接受过输血、手术中使用多于一张明胶海绵或使用止血粉，手术时间较长，术中失血量较多（P  <  0.05）。(3) 在多因素分析中，三个因素被确定为独立危险因素，其中包括翻修手术（P =  0.021, OR  =  7.667)、更长的 TT ( P  =  0.027, OR  =  2.586) 以及在手术中使用不止一种明胶海绵或使用止血粉 ( P  =  0.012, OR  =  9.000)。

结论

翻修手术（P  =  0.021，OR  =  7.667）、较长的TT（P  =  0.027， OR  =  2.586）和手术中使用超过一种明胶海绵或使用止血粉是TLIF术后SEH的独立危险因素。