Analysis Of The Risk Factors For The Symptomatic Postoperative Spinal Epidural Hematoma

Objective: To analyze the risk factors for symptomatic epidural hematoma after spinal surgery to guide clinical work to reduce its incidence.Materials and Methods: The clinical data of patients who underwent spinal surgery in the Department of Spinal Surgery of the Dalian Medical Affiliated Second Hospital in 2013-2018 were selected.The symptomatic epidural hematoma group(hereinafter referred to as hematoma group)after spinal surgery was included in the criteria: 1.Open spinal surgery in our hospital,2.Complete clinical data,3.No coagulation abnormality before operation,4.Surgery completed After the anesthesia was fully awake,the sensorimotor movement and reflex status of the limbs improved better than that before surgery.5.Postoperative limb dysfunction and progressive aggravation.6.Surgical confirmation of epidural hematoma after spinal surgery and compression of the spinal cord.The inclusion criteria of the control group were as follows: 1.Open spinal surgery in our hospital,2.Complete clinical data of the patient,3.No abnormal blood coagulation before operation,4.Lower limb sensorimotor movement and reflex state after the anesthesia was completely awake after the operation was completed.Before the improvement,5.There was no limb sensorimotor dysfunction after operation.According to the risk factors listed in the previous literature,the preoperative risk factors include age,gender,non-steroidal drugs and antiplatelet drug use,preoperative hemoglobin,Rh blood type,history of hepatitis C,hypertension,drinking history,Body mass index(BMI),intraoperative absorption factors including surgical segment, intraoperative blood loss,autologous blood transfusion device,use of blood products and gelatin sponge,duration of surgery,postoperative risk factors including anticoagulant drugs and non-The use of steroids and drainage.All statistical data were statistically processed by SPSS20.0 software.The t-test was used for the measurement data,and the X~2 test was used for the count data.The logistic regression curve was used to exclude the unrelated factors(P<0.05 was considered statistically significant).Results: The results of regression analysis showed that the intraoperative blood loss was ?1L and the surgical site was a risk factor for symptomatic epidural hematoma after spinal surgery.The incidence of thoracic hematoma was the highest,followed by cervical vertebrae.Lumbar vertebrae.There was no statistically significant difference in the duration of surgery,the segment of the operation,the use of intraoperative blood products,and the operation time of 3 hours or more,that is,they were not risk factors for postoperative epidural hematoma.Conclusion: Symptomatic epidural hematoma after spinal surgery is a rare but very serious complication.Early diagnosis and early treatment must be done.Among the many reported risk factors,we only found two The influential risk factors are intraoperative blood loss ?1L and surgical site.The surgical site is determined by the patient's disease,and we can only achieve adequate hemostasis during spinal surgery.