加速康复外科在OLIF结合前路内固定治疗腰椎管狭窄症合并退变性不稳中的应用  

Application of enhanced recovery after surgery in oblique lateral interbody fusion combined with anterior fixation in the treatment of lumbar spinal stenosis with degenerative instability

作　　者：杨志强 曾建成[1] 李涛[1] 龚全[1] 刘立岷[1] 修鹏[1] 周忠杰[1] 薛镜[1] 王朝杨 宋跃明[1] 刘浩[1] YANG Zhi-qiang;ZENG Jian-cheng;LI Tao;GONG Quan;LIU Li-min;XIU Peng;ZHOU Zhong-jie;XUE Jing;WANG Chao-yang;SONG Yue-ming;LIU Hao(Department of Orthopaedics,West China Hospital,Sichuan University,Chengdu,Sichuan,610041,China)

机构地区：[1]四川大学华西医院骨科

出　　处：《中国骨与关节杂志》2020年第1期33-38,共6页Chinese Journal of Bone and Joint

摘　　要：目的研究加速康复外科 (enhanced recovery after surgery,ERAS) 在斜外侧腰椎椎体间融合术(oblique lumbar interbody fusion,OLIF) 结合前路内固定治疗腰椎管狭窄症合并退变性不稳中的应用效果。方法2017 年 2 月至 2018 年 1 月,我院采用 OLIF 结合前路内固定治疗腰椎管狭窄症合并退变性不稳 (单节段) 患者 120 例,按照患者就诊时间,分为对照组 (60 例) 和实验组 (ERAS 组,60 例),分别对患者围术期采取脊柱外科常规管理和 ERAS 管理。记录患者手术时间、术中出血量、术后卧床至下床活动间隔时间、住院时间、术后并发症等指标。采用疼痛视觉模拟评分 (visual analogue scale,VAS) 评估术前及术后疼痛,采用 Oswestry 功能障碍指数 (oswestry disability index,ODI) 评估术前术后腰椎的功能。末次随访时改良 MacNab 标准评估治疗效果。结果所有患者均顺利完成手术,一期完成减压融合固定操作。两组患者手术时间差异无统计学意义 (P>0.05)。ERAS 组:术中出血量 (37.7±5.5) ml,术后卧床至下床活动间隔时间 (10.7±2.6) h,住院时间(6.9±0.7) 天;对照组:术中出血量 (49.4±8.6) ml,术后卧床至下床活动间隔时间 (17.3±3.2) h,住院时间(9.8±1.9) 天,两组患者术中出血量、术后卧床至下床活动间隔时间、住院时间差异有统计学意义 (P<0.05)。ERAS 组术后 3 天 [VAS (3.72±1.16),ODI (34.46±8.63)]、术后 1 个月 [VAS (2.16±0.35),ODI (25.7±7.15)] 随访时 VAS 及 ODI 均优于对照组 [术后 3 天 VAS (4.86±1.58),ODI (43.16±7.13);术后 1 个月 VAS(3.34±1.01),ODI (32.6±6.14)],差异有统计学意义 (P<0.05)。ERAS 组术后 12 个月 (末次) 随访时优良率高于对照组。两组患者术中均无手术节段错误、血管损伤、神经根撕裂等,术后无椎间隙感染、脑脊液漏、伤口感染病例,无术后再住院病例。ERAS 组 (3 / 60,5.0%) 术后并发症发生率明显低于对照组 (11 / 60,18.3%),差异有统计学意义,Objective To study effects of enhanced recovery after surgery (ERAS) in oblique lateral interbody fusion (OLIF) combined with anterior fixation in the treatment of lumbar spinal stenosis with degenerative instability.Methods From February 2017 to January 2018,120 patients diagnosed as lumbar spinal stenosis with degenerative instability (single segment) were treated with OLIF combined with anterior fixation.All were divided into the control group (n=60) and experimental group (ERAS group,n=60) according to patients’ admission time.Routine and ERAS intervention were adopted perioperatively.Operation time,intraoperative bleeding,off-bed time,hospital stay and complications were recorded.Visual Analogue Scale (VAS) was used to evaluate the pain,and the Oswestry Disability Index (ODI) to evaluate lumbar functions.Clinical outcomes were evaluated using MacNab criteria at the last follow-up.Results Decompression,fusion and fixation were achieved at the first stage.There were no significant differences in operation time between the two groups (P > 0.05).Intraoperative bleeding,off-bed time and hospital stay in the ERAS group [(37.7±5.5) ml,(10.7±2.6) h,(6.9±0.7) d] were lower / shorter than those in the control group [(49.4±8.6) ml,(17.3±3.2) h,(9.8±1.9) d] with statistical significance (P < 0.05).VAS and ODI of the ERAS group [3 days follow-up,VAS (3.72±1.16),ODI (34.46±8.63);1 month follow-up VAS(2.16±0.35),ODI (25.7±7.15)] were better than those of the control group [3 days follow-up VAS (4.86±1.58),ODI (43.16±7.13);1 month follow-up,VAS (3.34±1.01),ODI (32.6±6.14)] with statistical significance (P <0.05).The excellent and good rate of the ERAS group at the last follow-up was higher than that of the control group.No segmental errors,vascular injuries,nerve root tear,intervertebral space infection,cerebrospinal leakage,orre-hospitalization was observed.The incidence of complications (abdominal distension in particular) in ERAS group (3 / 60,5.0%) was significantly lower than that in the control group (

关 键 词：腰椎 脊柱融合术 椎管狭窄 加速康复外科 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]