腰大肌内封闭对多节段猫眼侧方入路腰椎椎体间融合术后早期并发症的影响  

Effect of psoas major intramuscular block therapy on the early complications related to the multi-segmental crenel lumbar interbody fusion

作　　者：钟泽祥 李方财[1] 陈其昕[1] 陈维善[1] 王智伟 陈临炜 许国萍[1] 沈元青 Zhong Zexiang;Li Fangcai;Chen Qixin;Chen Weishan;Wang Zhiwei;Chen Linwei;Xu Guoping;Shen Yuanqing(Department of Orthopaedics,The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Orthopaedics,Shaoxing Yuecheng People's Hospital,Shaoxing 312000,China)

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310000 [2]绍兴市越城区人民医院骨科,312000

出　　处：《中华骨科杂志》2021年第13期825-833,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81702220);浙江省医药卫生科技省部共建重大项目(WKJ-ZJ-1903);浙江省医药卫生科技项目面上项目(2021423642)。

摘　　要：目的探讨术中腰大肌内封闭对多节段猫眼侧方入路腰椎椎体间融合术(crenel lumbar interbody fusion,CLIF)入路相关并发症的影响。方法2020年1月至2020年6月接受多节段CLIF治疗退行性腰椎侧凸患者68例,根据术中是否进行腰大肌内封闭进行分组。封闭组在闭合切口前在腰大肌内填塞浸润得宝松及利多卡因混合液的凝胶海绵,而对照组则不填塞。封闭组35例,男9例,女26例;年龄(68.0±6.5)岁(范围54~85岁)。对照组33例,男7例,女26例;年龄(66.5±7.1)岁(范围54~81岁)。分别记录术后第1天、1周、1和3个月的入路相关并发症,主要包括大腿前方疼痛、麻木和腰大肌、股四头肌肌力。主要观察指标为疼痛视觉模拟评分(visual analogue scale,VAS)、麻木VAS评分,腰大肌、股四头肌肌力以及入路相关的并发症。临床疗效评估采用Oswestry功能障碍指数(Oswestry disability index,ODI)和腰痛VAS评分。影像学评估采用侧凸Cobb角及矢状面平衡(sagittal vertical axis,SVA)等。结果两组患者年龄、性别、体质指数(body mass index,BMI)、融合节段数、手术时间、术中出血量的差异均无统计学意义。封闭组患者入路相关并发症发生率为17.1%,对照组为39.4%,差异有统计学意义(χ2=4.177,P=0.041)。封闭组术后大腿前方疼痛及腰大肌肌力减退的发生率分别为11.4%和14.3%,均低于对照组的33.3%和36.4%(χ2=4.740,P=0.029;χ2=4.416,P=0.036);术后大腿前方麻木的发生率(14.3%)虽低于对照组(21.2%),但差异无统计学意义(χ2=0.561,P=0.454)。两组术后均无股四头肌肌力减退者。封闭组术后第1天、1周、1个月大腿前方疼痛VAS评分均低于对照组(t=2.220,P=0.031;t=2.235,P=0.031;t=2.086,P=0.044),差异均有统计学意义;术后3个月的差异无统计学意义(t=0.385,P=0.701)。封闭组术后第1天、1周腰大肌肌力均高于对照组(t=2.208,P=0.032;t=2.171,P=0.034),差异有统计学意义;术后1、3个月的差异均无统计Objective To explore the clinical effect of the application of intraoperative psoas major intramuscular block therapy on the complications related to the approach after multi-segmental crenel lumbar interbody fusion(CLIF).Methods All of 68 degenerative lumbar scoliosis patients who had received multi-segmental crenel lumbar interbody fusion during January 2020 and June 2020 were retrospectively reviewed.Patients were divided into two groups according to whether the psoas major muscle was treated with block therapy during the operation.The psoas muscle inblock group were filled with gel sponge infiltrated with a mixture of Betamethasone and lidocaine for local block therapy before closing the incision while that in the control group were not filled with gel sponge.There were 33 patients in the control group,7 males and 26 females with an average of 65.8±7.1 years old(range:54-81 years old);35 cases in the block group,9 males and 26 females with an average of 68.0±6.5 years old(range:54-85 years old).The complications related to the approach(mainly includes pain,numbness in the front of the thigh,as well as psoas major,quadriceps muscle strength)were recorded respectively 1 day,1 week,1 month and 3 months after surgery.The main indicators of outcome including visual analog scale(VAS)of pain,the visual analog scale(VAS)of numbness,muscle strength of psoas major and quadriceps femoris,and the incidence of complications related to the approach were compared between the two groups of patients at different time points after surgery.The clinical outcomes were assessed using the Oswestry disability index(ODI),VAS for low back pain.The radiological outcome was evaluated with Cobb angles and sagittal balance parameters(sagittal vertical axis,SVA).Results There were no significant differences in age,gender,body mass index(BMI),number of fusion segments,operation time,and intraoperative blood loss between the two groups.The incidence of approach-related complications was 17.1%in the block group and 39.4%in the control group

关 键 词：腰椎 脊柱融合术 封闭疗法 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]