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Lumbar disc herniation is one of the common orthopedic diseases. Percutaneous endoscopic lumbar discectomy (PELD) has gradually become a first-line surgical approach. Compared with open discectomy and open lumbar microdiscectomy, PELD has shorter operation time, less bleeding and lower complication rate, but the postoperative recurrence rate is relatively high and the learning curve is steep. Unilateral biportal endoscopic discectomy and full endoscopic transforaminal lumbar interbody fusion may be effective supplements to PELD. New technologies such as the combination of navigation and 3D printing technology, multi-mode nonlinear optical microscope, the combination of nuclear magnetic resonance imaging and artificial intelligence (such as deep learning and convolution neural network) will help to improve the accuracy of positioning and tissue discrimination of PELD, predict the surgical difficulty and postoperative recurrence, shorten the learning curve, and promote the popularization and application of PELD.
RESUMEN
Objective:To evaluate the risk factors of venous thromboembolism (VTE) after lower extremity orthopedic surgery in the elderly.Methods:The case data of 114 patients who underwent lower extremity orthopedic surgery in Jingdong Yumei Integrated Traditional Chinese and Western Medicine Kidney Disease Hospital from January 2018 to January 2019 were retrospectively collected. According to the presence or absence of VTE, they were divided into non VTE group (103 cases) and VTE group (11 cases). Univariate and multivariate logistic regression were used to analyze the independent risk factors of VTE after lower extremity surgery in the elderly. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the predictive efficacy of independent risk factors for VTE.Results:Compared with the non VTE group, the VTE group had more male patients, less preventive application of traditional Chinese medicine, higher preoperative D-dimer levels, longer operation time and less drainage 48 hours after operation (all P<0.05). Multivariate analysis showed that long operation time was an independent risk factor for VTE ( OR=1.021, 95% CI: 1.007-1.036, P=0.004), and more postoperative drainage was an independent protective factor for VTE ( OR=0.993, 95% CI: 0.988-0.998, P=0.006). The AUC of VTE predicted by operation time and postoperative drainage volume were 0.691 (95% CI: 0.548-0.834, P=0.038) and 0.767 (95% CI: 0.679-0.856, P=0.004), respectively. The AUC of combined diagnosis of the two was 0.807 (95% CI: 0.731-0.883, P=0.001). Conclusions:The operation time >107 min and the drainage volume <225 ml 48 hours after operation are independent risk factors for VTE in elderly patients undergoing lower extremity orthopedic surgery. Orthopedic doctors should try to shorten the operation time and keep the postoperative drainage unobstructed in order to reduce the incidence of VTE.