腰椎手术后典型引流管相关疼痛的回顾性分析及前瞻性观察  

Retrospective and prospective observation of typical drainage-related pain after lumbar surgery

作　　者：段晓鹏 陈锴[1] 付清诚 刘兆辰[3] 翟骁[1] 毛宁方[1] 李明[1] DUAN Xiao-peng;CHEN Kai;FU Qing-cheng;LIU Zhao-chen;ZHAI Xiao;MAO Ning-fang;LI Ming(Department of Orthopaedics,Changhai Hospital,Naval Medical University(Second Military Medical University),Shanghai 200433,China;Department of Hematology,Changzheng Hospital,Naval Medical University(Second Military Medical University),Shanghai 200003,China;Scientific Research Office,Changhai Hospital,Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)长海医院骨科,上海200433 [2]海军军医大学(第二军医大学)长征医院血液科,上海200003 [3]海军军医大学(第二军医大学)长海医院科研科,上海200433

出　　处：《第二军医大学学报》2020年第3期281-286,共6页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金(81701199);重大疑难疾病中西医临床协作试点项目[ZY(2018-2020)-FWTX-2005].

摘　　要：目的探讨腰椎手术后典型引流管相关疼痛(TDRP)的发生情况及预防措施。方法回顾性分析2015年1月至2017年1月海军军医大学(第二军医大学)长海医院骨科收治的接受单节段后路腰椎椎体间融合术(PLIF)治疗的336例腰椎退行性病变患者的临床资料,比较引流管出肌点与L3、L4、L5、S1椎体平齐患者PLIF术后TDRP的发生情况及缓解方式。前瞻性选择2017年6月至2018年6月海军军医大学(第二军医大学)长海医院骨科收治的因腰椎退行性病变拟行单节段经椎间孔腰椎椎体间融合术(TLIF)的100例患者,随机选取患者一侧为L4组,另一侧为L5组:L4组引流管出肌点与L4椎体上缘平齐,L5组引流管出肌点与L5椎体下缘平齐,比较两组术后TDRP的发生情况及缓解方式、引流量、引流管留置时间、切口敷料渗出和伤口并发症发生率等。结果PLIF术后发生TDRP(n=65)和不发生TDRP(n=271)的患者性别、年龄、BMI、手术时间、术中失血量、术后引流量、引流管留置时间、术后发热持续时间差异均无统计学意义(P均>0.05),术前1 d、术后3 d、出院时血红蛋白和血细胞比容差异亦均无统计学意义(P均>0.05)。336例患者中,PLIF术后引流管出肌点与L3、L4、L5、S1椎体平齐者分别为63、94、110、69例,术后TDRP发生率分别为0、5.32%(5例)、29.09%(32例)、40.58%(28例);65例术后发生TDRP的患者中,4例(6.15%)在拔除引流管后疼痛即缓解,5例(7.69%)在拔除引流管后通过改变体位疼痛突然缓解,39例(60.00%)在拔除引流管后经热敷理疗疼痛明显缓解(一般在2个月内缓解),12例(18.46%)在拔除引流管后通过非甾体抗炎药治疗疼痛缓解,5例(7.69%)在拔除引流管后通过封闭治疗疼痛缓解。前瞻性研究中,L4组和L5组术后引流量、引流管留置时间、术后第2天伤口渗出情况及伤口并发症发生率的差异均无统计学意义(P均>0.05)。L5组39例(39.00%)患者TLIF术后发生TDRP,发生率Objective To explore the incidence and precautionary methods of typical drainage-related pain(TDRP)after lumbar surgery.Methods The clinical data of 336 patients with degenerative lumbar disease,who underwent single-level posterior lumbar interbody fusion(PLIF)surgery from Jan.2015 to Jan.2017 in Orthopaedics Department of Changhai Hospital of Naval Medical University(Second Military Medical University),were retrospectively analyzed.The incidence and relief methods of TDRP were compared between the patients with exit point of muscle of drainage tube at L3,L4,L5 and S1 levels.A total of 100 patients with degenerative lumbar disease,who underwent single-level transforaminal lumbar interbody fusion(TLIF)surgery from Jun.2017 to Jun.2018 in Orthopaedics Department of Changhai Hospital of Naval Medical University(Second Military Medical University),were prospectively enrolled.One side of the patients was randomly selected as L4 group and the other side as L5 group.The exit points of muscle of drainage tubes in L4 group were in line with the superior endplate of the L4,and those in L5 group were in line with the inferior endplate of the L5.The incidence and relief methods of TDRP,drainage volume,drainage duration,dressing saturation grades and wound complications were compared between the two groups after surgery.Results There were no significant differences in gender,age,body mass index(BMI),operation time,intraoperative blood loss,postoperative drainage volume,drainage duration,duration of fever,or hemoglobin or hematocrit one day before surgery,three days after surgery and at discharge between the patients with TDRP(n=65)and without TDRP(n=271)after PLIF(all P>0.05).There were 63,94,110 and 69 patients with exit points of muscle of drainage tube at L3,L4,L5 and S1 levels,respectively;and the incidence rates of TDRP were 0,5.32%(5 cases),29.09%(32 cases)and 40.58%(28 cases),respectively.Among the 65 patients with TDRP,four patients(6.15%)were relieved after removal of drainage tube,five patients(7.69%)had sudden reli

关 键 词：引流术 疼痛 出肌点 后路腰椎椎体间融合术 经椎间孔腰椎椎体间融合术 

分 类 号：R681.533[医药卫生—骨科学]