微创手术与开放性手术治疗腰椎间盘突出症的疗效比较与并发症护理  

Comparison of efficacy between minimally invasive surgery and open surgery in the treatment of lumbar disc herniation and nursing for complication

作　　者：缪洁[1] 赵金彩[1] 安永慧[1] 何丽英[1] 张一[1] 王大随[1] 刘俊英[1] 

机构地区：[1]河北医科大学第三医院骨科,石家庄050051

出　　处：《中华现代护理杂志》2014年第13期1540-1543,共4页Chinese Journal of Modern Nursing

基　　金：河北省卫生厅基金项目（10276105D23）

摘　　要：目的 探讨经Quadrant通道下微创手术与开放性手术治疗腰椎间盘突出症的疗效及并发症的有效护理方法.方法 选取2011年1月-2012年1月行腰椎后路手术的115例腰椎间盘突出症患者,男79例,女36例.根据手术方式分为两组：Quadrant微创TLIF组（Mini-TLIF,53例）和开放性TLF组（Open-TLIF,62例）.对两组患者的手术切口长度、术中出血量、症状改善、术后引流量、术后下地活动时间、术后住院时间及并发症等方面进行对比分析,进而探讨有效护理方法.结果 两组患者在手术切口长度、术中出血量、术后引流量、术后下地活动时间、术后住院时间方面比较,Mini-TLIF组优于Open-TLIF组,两组比较差异有统计学意义（t分别为16.91,57.72,56.55,11.20,12.46;P＜0.01）.Mini-TLIF和Open-TLIF两组患者在治疗前后视觉模拟评分（VAS）改善差异有统计学意义（t分别为34.108,40.964;P ＜0.01）,但在治疗前后组间比较VAS评分差异无统计学意义（P＞0.05）.Mini-TLIF组术后发生下肢静脉血栓1例,Open-TLIF组术后发生下肢静脉血栓21例和伤口血肿10例;两组术后下肢静脉血栓和伤口血肿并发症方面比较差异均有统计学意义（x2分别为18.894,7.441;P ＜0.01）.结论 两种手术方式均能有效改善腰椎间盘突出症患者的腰腿痛症状,但是经Quadrant通道下微创手术在手术切口长度、术中出血量、术后引流量、术后下地活动时间、术后住院时间均较开放性TLIF小或少,患者术后痛苦小、卧床时间短、恢复快,不仅减少了术后并发症的发生率,同时也极大地减轻了临床护理负担.Objective To explore the curative effect between via Quadrant minimally invasive surgery and open surgery in the treatment of lumbar disc herniation （LDH） and the effective nursing method for complication.Methods One hundred and fifteen LDH patients including 79 males and 36 females from January 2011 to January 2012 were chosen and divided into the via Quadrant minimally invasive operation transforaminal lumbarinterbody fusion（TLIF） group （Mini-TLIF,n =53） and the open surgery TLIF group （Open-TLIF,n =62）.The length of incision,operative blood loss,symptom improvement,postoperative drainage,the time of postoperative ambulation and hospitalization,the incidence of complications were analyzed and compared between two groups to further explore the effective nursing method.Results The length of incision,operative blood loss,postoperative drainage,the time of postoperative ambulation and hospitalization in the Mini-TLIF group were better than those in the Open-TLIF group,and the differences were statistically significant （t =16.91,57.72,56.55,11.20,12.46,respectively; P 〈 0.01）.The difference was found in the score of Visual Analogue Scale before and after treatment in each group （t =34.108,40.964,respectively; P 〈0.01）,but no difference was found before and after treatment between two groups （P 〉 0.05）.The cases of deep vein thrombosis and wound hematoma were respectively 1,0 case in the Mini-TLIF group,and were 21,10 cases in the Open-TLIF group,and the differences were statistically significant （x2 =18.894,7.441,respectively; P 〈 0.01）.Conclusions Both mini-TLIF and open-TLIF can effectively improve the back and leg pain in LDH patients.However,mini-TLIF is lower or shorter than open-TLIF in the aspects of the length of incision,operative blood loss,postoperative drainage,the time of postoperative ambulation and hospitalization; and the LDH patients with mini-TLIF have less pain,the shorter time in bed,the faster recovery; and the mini-TLIF can not only reduce the incidence r

关 键 词：腰椎间盘突出症 经Quadrant通道微创手术 疗效 并发症 护理 

分 类 号：R473.6[医药卫生—护理学]