腰椎融合内固定术后皮下引流与深筋膜下肌层引流疗效对比  

Comparison of two different post-surgery drainages in patient with lumber fusion and internal fixation

作　　者：谭小云[1] 蒲涛[1] 刘计鲁 许轩铭 

机构地区：[1]解放军第413医院骨二科,舟山316000

出　　处：《浙江医学》2015年第17期1460-1462,1465,共4页Zhejiang Medical Journal

基　　金：全军医学科学技术研究"十二五"课题(CWS11J261)

摘　　要：目的 对比分析单节段腰椎减压融合内固定术后切口皮下引流与深筋膜下引流的疗效及安全性.方法 回顾分析2010年11月至2014年6月行单节段腰椎管减压腰椎间盘髓核摘除椎间植骨椎弓根内固定术的患者共148例,按术后引流方式不同分成皮下引流组（66例）和深筋膜下（肌层）引流组（82例）,统计分析两组患者切口敷料分级、术后置管时间、失血情况、硬脑膜外血肿发生率、切口感染、症状性深静脉血栓及肺栓塞等并发症.结果 术后第1天对所有患者切口敷料进行评估分级,皮下引流组切口敷料A级率为87.9％,深筋膜下（肌层）引流组为84.1％,切口敷料C级率皮下引流组为4.5％,深筋膜下（肌层）引流组为4.9％,差异均无统计学意义（均P＞0.05）.皮下引流组术后总引流量（215.10±90.12）ml,置管时间为（28.4±9.8）h;深筋膜下（肌层）引流组术后总引流量（395.47±138.49）ml,置管时间为（52.5±11.3）h,两组间比较均有统计学差异（均P＜0.05）.出院时两组切口愈合情况均较好.所有患者获得3～28（15.00±8.25）个月随访,均未出现切口血肿、感染、引起神经症状的硬脑膜外血肿、症状性深静脉血栓及肺栓塞等并发症.结论 单节段腰椎减压融合内固定术后切口深筋膜下引流总失血量要多于皮下引流,但两者临床疗效相当,均是一种安全、有效的引流方法.Objective To compare results of subcutaneous closed suction drainage with submuscular closed suction drainage after posterior correction in patient undergoing lumbar fusion and internal fixation. Methods The clinical data of 148 patients undergoing posterior instrument lumbar fusion in our hospital from November 2010 to June 2014 was retrospectively re- viewed. Among them 66 patients received subcutaneous drainage and 82 patients received submuscular drainage. The wound dressing grading, drainage duration,estimated blood loss,incidence of epidural hematoma,wound infection, symptomatic deep venous thrombosis and pulmonary embolism after surgery were documented and compared between two groups, Results On the first day after surgery, the grade A rate of the wound dressing in the subcutaneous drainage group was 87.9%, and the sub- muscular drainage was 84.1%; the grade C rate of the wound dressing in two groups was 4.5% and 4.9%, respectively （P 〉0.05）. The average drainage volume of the subcutaneous drainage group was（215.10±90.12）ml and that of submuscular drainage was （395.47 ± 138.49）ml,the average drainage duration of two groups was （28.4 ± 9.8 ）h and （52.5± 11.3）h, respectively（P〈0.05）.No wound infection and other complications was found in two groups. Conclusion Compared with submuscular closed suction drainage, subcutaneous closed suction drainage after posterior internal fixation and lumbar fusion can reduce postoperative drainage volume,drainage duration and blood transfusion,while not increase the wound infection,which can be used in clinical practice.

关 键 词：引流 腰椎融合 

分 类 号：R687.3[医药卫生—骨科学]