CAJ | 학술논문

目的探讨经椎弓根椎体截骨术(pediclesubtractionosteotomy，PSO)治疗强直性脊柱炎(ankylosingspondylitis，AS)后凸畸形术中大量出血(massivebloodloss，MBL)的预测因素。方法共收集147例PSO治疗AS后凸畸形的病例数据。其中106例资料完整，分为两组：A组( n＝69)术中出血量≥估计血容量的30%，B组( n＝37)术中出血量＜估计血容量的30%。比较两组患者术前数据，应用单因素分析大量出血所有可能的预测因素。应用多因素 Logitic 回归分析大量出血的独立危险因素。应用 Pearson 相关性检验分析全部106例大量出血的发生率与脊柱外科医生PSO手术积累量的关系。结果 A组患者(65%)中， GK角≥70°、固定节段数≥9、双节段截骨的例数比B组(35%)更多。Logistic回归分析显示固定节段数≥9以及双节段截骨是大量出血的独立危险因素。Pearson 相关性分析显示在一定范围内，大量出血的发生率随着脊柱外科医生PSO手术积累量的增加而下降，二者呈线性相关。结论 PSO手术治疗AS后凸畸形的患者中，大量出血的发生率为65%。术前 GK 角≥70°、双节段 PSO 截骨以及固定节段数≥9是大量出血的预测因素，后两者是独立预测因素。在一定范围内，随着脊柱外科医生 PSO手术量的积累，大量出血的发生率下降。
목적탐토경추궁근추체절골술(pediclesubtractionosteotomy，PSO)치료강직성척주염(ankylosingspondylitis，AS)후철기형술중대량출혈(massivebloodloss，MBL)적예측인소。방법공수집147례PSO치료AS후철기형적병례수거。기중106례자료완정，분위량조：A조( n＝69)술중출혈량≥고계혈용량적30%，B조( n＝37)술중출혈량＜고계혈용량적30%。비교량조환자술전수거，응용단인소분석대량출혈소유가능적예측인소。응용다인소 Logitic 회귀분석대량출혈적독립위험인소。응용 Pearson 상관성검험분석전부106례대량출혈적발생솔여척주외과의생PSO수술적루량적관계。결과 A조환자(65%)중， GK각≥70°、고정절단수≥9、쌍절단절골적례수비B조(35%)경다。Logistic회귀분석현시고정절단수≥9이급쌍절단절골시대량출혈적독립위험인소。Pearson 상관성분석현시재일정범위내，대량출혈적발생솔수착척주외과의생PSO수술적루량적증가이하강，이자정선성상관。결론 PSO수술치료AS후철기형적환자중，대량출혈적발생솔위65%。술전 GK 각≥70°、쌍절단 PSO 절골이급고정절단수≥9시대량출혈적예측인소，후량자시독립예측인소。재일정범위내，수착척주외과의생 PSO수술량적적루，대량출혈적발생솔하강。
Objective To investigate the predictors of massive blood loss ( MBL ) in pedicle subtraction osteotomy ( PSO ) in the treatment of spinal kyphosis caused by ankylosing spondylitis ( AS ).Methods A total of 147 patients with spinal kyphosis caused by AS underwent PSO, whose clinical data were collected. Among them, the data of 106 patients were complete, who were divided into 2 groups. In group A (n=69 ) the intraoperative blood loss was more than or equal to 30% of the estimated blood volume, and in group B (n=37 ) the intraoperative blood loss was less than 30% of the estimated blood volume. The preoperative data were compared between the 2 groups, and univariate analysis was undertaken to distinguish all the possible predictors of MBL. And a binary logistic regression analysis was used to determine the independent risk factors of MBL. The relationship between the incidence of MBL in all the 106 cases and the cumulative amount of PSO by spine surgeons was analyzed with the Pearson correlation test.Results There were more cases of double-segment osteotomy in group A ( 65% ) than in group B ( 35% ), with the global kyphosis ( GK )≥70o and the number of ifxation segments≥9. Logistic regression analysis showed that more than or equal to 9 ifxation segments and double-segment osteotomy were independent risk factors for MBL. The Pearson correlation test showed that the incidence of MBL was decreased with the increase of the cumulative amount of PSO by spine surgeons in a certain range and a linear correlation was found between them.Conclusions When PSO is performed in the treatment of spinal kyphosis caused by AS, the incidence of MBL is 65%. The predictors of MBL included the preoperative Cobb’s angle≥70o, double-segment PSO and number of ifxation segments≥9, and the last 2 predictors are independent. In a certain range, with the increase of the cumulative amount of PSO by spine surgeons, the incidence of MBL will be decreased.