Risk factors for hidden blood loss after percutaneous endoscopic unilateral laminotomy for bilateral decompression in elderly patients with lumbar spinal stenosis

MA Xiao-liang; ZHANG Ling-hao; ZHANG Hong-tao; ZHANG Hai-gang; LI Zhan-qi; ZHANG Wei-liang

doi:10.11659/jjssx.10E025011

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Risk factors for hidden blood loss after percutaneous endoscopic unilateral laminotomy for bilateral decompression in elderly patients with lumbar spinal stenosis

Minimally Invasive Orthopedic Techniques and Perioperative Safety | 更新时间：2026-07-24

- Risk factors for hidden blood loss after percutaneous endoscopic unilateral laminotomy for bilateral decompression in elderly patients with lumbar spinal stenosis
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 35, Issue 7, Pages: 574-578(2026)
- 作者机构：
  
  1.西安市人民医院/西安市第四医院疼痛科，陕西西安 710004
  2.陕西省血液中心体采一科，陕西西安 710061
  3.空军军医大学第二附属医院骨科，陕西西安 710038
  4.西安市人民医院/西安市第四医院脊柱外科，陕西西安 710004
- 作者简介：
- 基金信息：
- DOI：10.11659/jjssx.10E025011
  CLC： R681.5;R619
- Received：09 October 2025，
  
  Online First：24 July 2026，
  
  Published：25 July 2026
- 稿件说明：
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马晓亮,张铃浩,张弘韬等.老年腰椎管狭窄患者经皮脊柱内镜单侧椎板切开双侧减压术后隐性失血的危险因素分析[J].局解手术学杂志,2026,35(07):574-578.

MA Xiao-liang,ZHANG Ling-hao,ZHANG Hong-tao,et al.Risk factors for hidden blood loss after percutaneous endoscopic unilateral laminotomy for bilateral decompression in elderly patients with lumbar spinal stenosis[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(07):574-578.
马晓亮,张铃浩,张弘韬等.老年腰椎管狭窄患者经皮脊柱内镜单侧椎板切开双侧减压术后隐性失血的危险因素分析[J].局解手术学杂志,2026,35(07):574-578. DOI： 10.11659/jjssx.10E025011.

MA Xiao-liang,ZHANG Ling-hao,ZHANG Hong-tao,et al.Risk factors for hidden blood loss after percutaneous endoscopic unilateral laminotomy for bilateral decompression in elderly patients with lumbar spinal stenosis[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(07):574-578. DOI： 10.11659/jjssx.10E025011.

摘要

目的

探讨经皮脊柱内镜单侧椎板切开双侧减压术（Endo-ULBD）治疗老年腰椎管狭窄症（LSS）患者术后隐性失血（HBL）的发生及危险因素。

方法

回顾性分析西安市人民医院216例接受单节段Endo-ULBD治疗的老年LSS患者的临床资料，采用Gross公式计算术后HBL。采用单因素分析和

Spearman

秩相关分析筛选与HBL相关的因素；构建多因素线性回归模型分析HBL的独立相关因素。采用

Logistic

回归分析高HBL的危险因素，并评估模型的判别能力和校准度。

结果

216例患者术后HBL为372.51（322.46，409.23）mL，占总失血量（TBL）的89.32%。单因素分析发现，高血压、骨量减少或骨质疏松患者术后HBL更高（

0.05）；

Spearman

秩相关分析显示，手术时间及BMI与HBL呈正相关（

0.01）。多因素线性回归分析显示，手术时间（

=0.002，

=0.439，

0.001）、BMI（

=0.007，

=0.151，

=0.015）与术后HBL独立相关。进一步

Logistic

回归分析显示，手术时间是高HBL的独立危险因素（

=1.030，95%

：1.018~1.042，

0.001）；受试者工作特征（

ROC

）曲线分析显示，多因素

Logistic

回归预测模型的曲线下面积（

AUC

）为0.764（95%

：0.701~0.823），校准曲线显示模型拟合尚可。

结论

老年LSS患者经Endo-ULBD治疗后HBL较高。手术时间延长和BMI较高与术后HBL增加独立相关；其中手术时间是高HBL的独立危险因素。多因素

Logistic

回归预测模型具有中等判别能力和可接受校准度，但仍需外部验证。

Abstract

Objective

To investigate the occurrence and risk factors of hidden blood loss （HBL） after percutaneous endoscopic unilateral laminotomy for bilateral decompression （Endo-ULBD） in elderly patients with lumbar spinal stenosis （LSS）.

Methods

The clinical data of 216 elderly patients with LSS who underwent single‑segment Endo‑ULBD at Xi'an People's Hospital were retrospectively analyzed.The postoperative HBL was estimated using the Gross formula. Univariate analysis and

Spearman

rank correlation analysis were performed to screen factors associated with HBL. A multivariate linear regression model was constructed to identify the independent factors associated with HBL.

Logistic

regression was conducted to analyze risk factors for high HBL， and the model's discriminative ability and calibration were evaluated.

Results

The postoperative HBL in the 216 patients was 372.51 （322.46， 409.23）mL， accounting for 89.32% of the total blood loss （TBL）. Univariate analysis indicated that patients with hypertension， osteopenia or osteoporosis had significantly higher levels of postoperative HBL （

0.05）.

Spearman

rank correlation analysis revealed that operative time and BMI were positively correlated with HBL （

0.01）. Multivariate linear regression analysis demonstrated that operative time （

=0.002，

=0.439，

0.001） and BMI （

=0.007，

=0.151，

=0.015） were identified as independent factors associated with postoperative HBL. Further

Logistic

regression analysis demonstrated that operative time was an independent risk factor for high HBL （

=1.030， 95%

：1.018 to 1.042，

0.001）.

Receiver operating characteristic

（

ROC

） curve analysis showed that the

area under the curve

（

AUC

） of the multivariate

Logistic

regression prediction model was 0.764 （95%

： 0.701 to 0.823）， and the calibration curve indicated acceptable model fit.

Conclusion

Postoperative HBL accounted for a considerable proportion in elderly LSS patients undergoing Endo‑ULBD. Prolonged operative time and higher BMI were independently associated with increased postoperative HBL， with operative time identified as an independent risk factor for high HBL. The multivariate

Logistic

regression prediction model demonstrated moderate discriminative ability and acceptable calibration， although external validation is still required.

关键词

Keywords

references

中国康复医学会骨质疏松预防与康复专业委员会，中国老年保健协会骨科微创分会 . 退行性腰椎管狭窄症诊疗专家共识［J］. 中华骨与关节外科杂志， 2023 ， 16 （ 2 ）： 97 - 103 . doi： 10.3969/j.issn.2095-9958.2023.02.01 http://dx.doi.org/10.3969/j.issn.2095-9958.2023.02.01 .

袁超，刘超，沈俊宏，等 . 微创经椎间孔入路腰椎间融合术治疗重度腰椎管狭窄症［J］. 中国修复重建外科杂志， 2019 ， 33 （ 7 ）： 801 - 806 . doi： 10.7507/1002-1892.201903120 http://dx.doi.org/10.7507/1002-1892.201903120 .

Chiu RG ， Patel S ， Zhu A ， et al . Endoscopic versus open laminectomy for lumbar spinal stenosis： an international，multi-institutional analysis of outcomes and adverse events ［J］. Global Spine J ， 2020 ， 10 （ 6 ）： 720 - 728 . doi： 10.1177/2192568219872157 http://dx.doi.org/10.1177/2192568219872157 .

Kim HS ， Wu PH ， Jang IT . Lumbar endoscopic unilateral laminotomy for bilateral decompression outside-in approach： a proctorship guideline with 12 steps of effectiveness and safety ［J］. Neurospine ， 2020 ， 17 （ Suppl 1 ）： S99 - S109 . doi： 10.14245/ns.2040078.039 http://dx.doi.org/10.14245/ns.2040078.039 .

Li X ， Ding W ， Zhao R ， et al . Risk factors of total blood loss and hidden blood loss in patients with adolescent idiopathic scoliosis： a retrospective study ［J］. Biomed Res Int ， 2022 ， 2022 ： 9305190 . doi： 10.1155/2022/9305190 http://dx.doi.org/10.1155/2022/9305190 .

Zhuang H ， Li J ， Guo S ， et al . Hidden blood loss in three different endoscopic spinal procedures for lumbar disc herniation ［J］. Ann Med Surg （Lond）， 2024 ， 86 （ 2 ）： 655 - 659 . doi： 10.1097/MS9.0000000000001644 http://dx.doi.org/10.1097/MS9.0000000000001644 .

中国老年保健协会 . 脊柱大手术围术期血液管理专家共识［J］. 中国脊柱脊髓杂志， 2022 ， 32 （ 11 ）： 1049 - 1056 . doi： 10.3969/j.issn.1004-406X.2022.11.12 http://dx.doi.org/10.3969/j.issn.1004-406X.2022.11.12 .

Zhou Y ， Fu X ， Yang M ， et al . Hidden blood loss and its possible risk factors in minimally invasive transforaminal lumbar interbody fusion ［J］. J Orthop Surg Res ， 2020 ， 15 （ 1 ）： 445 . doi： 10.1186/s13018-020-01971-5 http://dx.doi.org/10.1186/s13018-020-01971-5 .

周宗科，翁习生，孙天胜，等 . 中国骨科手术加速康复——围术期血液管理专家共识［J］. 中华骨与关节外科杂志， 2017 ， 10 （ 1 ）： 1 - 7 . doi： 10.3969/j.issn.2095-9958.2017.01-01 http://dx.doi.org/10.3969/j.issn.2095-9958.2017.01-01 .

Jang JN ， Song Y ， Kim JW ， et al . Comparison of ligamentum flavum thickness between central and lateral lesions in a patient with central lumbar spinal canal stenosis ［J］. Medicine （Baltimore）， 2023 ， 102 （ 33 ）： e34873 . doi： 10.1097/MD.0000000000034873 http://dx.doi.org/10.1097/MD.0000000000034873 .

Hu M ， Zhang Y ， Zhao WJ ， et al . Perioperative hidden blood loss in lumbar disk herniation patients with percutaneous endoscopic transforaminal discectomy and influencing factors ［J］. Clin Spine Surg ， 2022 ， 35 （ 5 ）： E438 - E443 . doi： 10.1097/BSD.0000000000001282 http://dx.doi.org/10.1097/BSD.0000000000001282 .

谭海宁，于凌佳，谢学虎，等 . 单通道全脊柱内镜治疗腰椎管狭窄症的隐性失血及危险因素因素分析［J］. 中华腔镜外科杂志（电子版）， 2023 ， 16 （ 4 ）： 233 - 238 . doi： 10.3877/cma.j.issn.1674-6899.2023.04.007 http://dx.doi.org/10.3877/cma.j.issn.1674-6899.2023.04.007 .

Wang H ， Wang K ， Lv B ， et al . Analysis of risk factors for perioperative hidden blood loss in unilateral biportal endoscopic spine surgery： a retrospective multicenter study ［J］. J Orthop Surg Res ， 2021 ， 16 （ 1 ）： 559 . doi： 10.1186/s13018-021-02698-7 http://dx.doi.org/10.1186/s13018-021-02698-7 .

Zhou S ， A J ， Xu X ， et al . Comparison of surgical invasiveness and hidden blood loss between unilateral double portal endoscopic lumbar disc extraction and percutaneous endoscopic interlaminar discectomy for lumbar spinal stenosis ［J］. J Orthop Surg Res ， 2024 ， 19 （ 1 ）： 778 . doi： 10.1186/s13018-024-05274-x http://dx.doi.org/10.1186/s13018-024-05274-x .

Jin JF ， Chen HR ， Peng YJ ， et al . Risk factors for hidden blood loss in unilateral biportal endoscopic lumbar interbody fusion： a single-center retrospective study ［J］. BMC Musculoskelet Disord ， 2024 ， 25 （ 1 ）： 1017 . doi： 10.1186/s12891-024-08104-7 http://dx.doi.org/10.1186/s12891-024-08104-7 .

Liang H ， Zhao X ， Wang L ， et al . Risk factors for perioperative hidden blood loss after one-segment posterior circumferential decompression surgery on thoracic ossification of the posterior longitudinal ligament： a finding of the double-layer sign on CT ［J］. BMC Musculoskelet Disord ， 2023 ， 24 （ 1 ）： 223 . doi ： 10.1186/s12891-023-06352-7 http://dx.doi.org/10.1186/s12891-023-06352-7 .

Kwaifa IK ， Bahari H ， Yong YK ， et al . Endothelial dysfunction in obesity-induced inflammation： molecular mechanisms and clinical implications ［J］. Biomolecules ， 2020 ， 10 （ 2 ）： 291 . doi： 10.3390/biom10020291 http://dx.doi.org/10.3390/biom10020291 .

Song JC ， Yang LK ， Zhao W ， et al . Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy ［J］. Mil Med Res ， 2021 ， 8 （ 1 ）： 25 . doi： 10.1186/s40779-021-00317-4 http://dx.doi.org/10.1186/s40779-021-00317-4 .

Lei F ， Li Z ， He W ， et al . Hidden blood loss and the risk factors after posterior lumbar fusion surgery： a retrospective study ［J］. Medicine （Baltimore）， 2020 ， 99 （ 19 ）： e20103 . doi： 10.1097/MD.0000000000020103 http://dx.doi.org/10.1097/MD.0000000000020103 .

Kara GK ， Kavak H ， Gökçen B ， et al . The effects of patient related factors on hidden and total blood loss in single-level open transforaminal lumbar interbody fusion surgery ［J］. Acta Orthop Traumatol Turc ， 2022 ， 56 （ 4 ）： 262 - 267 . doi： 10.5152/j.aott.2022.21380 http://dx.doi.org/10.5152/j.aott.2022.21380 .

柳扬，张怀华，范磊，等 . PLIF围手术期隐性失血相关影响因素初步分析［J］. 实用骨科杂志， 2016 ， 22 （ 6 ）： 496 - 498 . doi： 10.13795/j.cnki.sgkz.2016.06.005 http://dx.doi.org/10.13795/j.cnki.sgkz.2016.06.005 .

Varra FN ， Varras M ， Varra VK ， et al . Molecular and pathophysiological relationship between obesity and chronic inflammation in the manifestation of metabolic dysfunctions and their inflammation-mediating treatment options （review）［J］. Mol Med Rep ， 2024 ， 29 （ 6 ）： 95 . doi： 10.3892/mmr.2024.13219 http://dx.doi.org/10.3892/mmr.2024.13219 .

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