经椎弓根截骨矫形治疗僵硬性脊柱侧凸手术出血量的影响因素分析

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Abstract Objective To identify the predictors of intraoperative blood loss in pedicle subtraction osteotomy(PSO) surgery for rigid scoliosis.Methods Data of 103 patients treated with PSO surgery for rigid scoliois by a single surgeon from January 2010 to September 2016 were retrospectively analyzed.Sex，age，preoperative height，preoperative weight，BMI，scoliosis type，preoperative Cobb angle，correction rate on Cobb angle，rib resection，intraspinal anomalies，fused levels，surgical procedures，the number of pedicle screws，preoperative laboratory examination(hemoglobin，platelet count，PT，APTT，and INR) were recorded and analyzed with a multivariable linear stepwise regression to develop a predictive model of blood loss.Pearson's correlation was also calculated between operation time and blood loss.Results Intraoperative blood loss was (2 311.1±1 123.1)mL(range，700 to 6 500 mL)，operation time was positively correlated to blood loss(Pearson's correlation 0.463，P＜0.000 1).Multivariate linear regression identified age，scoliosis type，the number of pedicle screws，preoperative Cobb angle as predictors of increased blood loss.The following formula was developed to predict blood loss during PSO surgery for rigid scoliosis：t＝－1 562.8＋42.6A＋629.0B＋78.8C＋9.9D.T was Blood loss(mL)，A wasage(year)，B was scoliosis type(AIS＝0，congenital scoliosi＝1)，C was number of pedicle screws，D waspreoperative Cobb angle of main coronal curve(degree).Conclusion Age，scoliosis type，the number of pedicle screws，preoperative Cobb angle of main coronal curve are the predictors of blood loss，and a formula has been developed to predict the blood loss.Surgeons can use this model to predict blood loss while making small adjustments.Operation time is positively correlated with blood loss，measures should be taken to reduce the operation time，then avoid massive blood loss in PSO surgery for rigid scoliosis.

Key words： rigid scoliosis pedicle subtraction osteotomy blood loss predictors

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