腰椎后路手术中减少自动拉钩的使用对术后恢复的影响  

The Influence of Reducing Use of Automatic Retractor on Postoperative Recovery in Posterior Lumbar Surgery

作　　者：吴春屾[1] 邹俊[1] 曹成[1] 包肇华[1] 周明[1] 杨惠林[1] 罗宗平[1] 

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215000

出　　处：《实用骨科杂志》2012年第10期868-871,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨腰椎后路手术中减少使用自动拉钩与患者术后恢复的关系。方法回顾性分析我院自2011年1月至11月行单节段椎弓根螺钉内固定结合经后路椎体间融合治疗的腰椎间盘突出症合并腰椎不稳患者42例,其中术中不使用自动拉钩的连续患者21例(A组),术中常规使用自动拉钩牵开椎旁肌的连续患者21例(B组)。对两组术中出血量、手术时间、术后引流量、术前、术后3d及术后6个月腰痛目测视觉类比评分法(visual analogue scale,VAS)、术前及术后6个月Oswestry功能障碍指数(oswestry disability index,ODI)评分进行比较。结果 42例患者全部获得随访,均随访6个月,两组术后症状均明显改善,内固定位置满意,无螺钉松动、断裂等并发症。A组术中出血量及术后引流量皆少于B组,差异有统计学意义(P<0.05),两组手术时间无明显差异,A组术后3d及半年VAS评分低于B组,差异有统计学意义(P<0.05)。术后6个月Oswestry功能障碍指数(ODI)A组低于B组,差异有统计学意义(P<0.05)。结论腰椎后路手术中减少自动拉钩的使用,避免椎旁肌的长时间牵拉,对于减轻患者术后腰背部疼痛,帮助患者恢复起着不可忽略的作用,值得引起临床医生在手术中注意。Objective To explore the influence of reducing the use of automatic retractor on postoperative recovery in the posterior lumbar surgery.Methods A total of 42 patients with lumbar disc herniation with segmental instability underwent single segment posterior lumbar interbody fusion from January 2011 to November 2011.They were divided into two groups according to the using of automatic retractor or not：group A underwent surgical procedure without using automatic retractor（21 cases）;group B underwent surgical procedure with using automatic retractor（21 cases）.The operation time and volume of blood losing were recorded,and the total volume of drainage after operation were also observed.The visual analog scal（VAS） and Oswestry disability score index（ODI） were measured.Results All cases were followed-up for six months,the symptom were obviously improved in all cases.And the fixation position were satisfactory.There were no screw loosening,fracture and other complications.There was no obvious difference in the result of operation time.The volume of blood losing and the total volume of drainage after operation in group A were less than group B,and the differences were statistically significant（P0.05）.And group A was also better than group B in low back pain VAS and Oswestry disability score index（ODI）,and the differences were statistically significant（P0.05））.Conclusion Reducing the use of automatic retractor in the posterior lumbar surgery contribute to reduce the postoperative lumbar back pain.

关 键 词：腰椎后路椎体间融合 椎旁肌损伤 术后疼痛 自动拉钩 下腰痛 

分 类 号：R683.2[医药卫生—骨科学]