颈椎单开门手术入路对围手术期加速康复外科进程的影响  

Influence of surgical approach for cervical open door laminoplasty in the process of enhanced recovery after surgery

作　　者：陈欣[1] 林俊桂 赵衍斌 周非非[1] 刁垠泽[1] 潘胜发[1] 夏天[1] 王少波[1] 孙宇[1] CHEN Xin;LIN Jungui;ZHAO Yanbin;ZHOU Feifei;DIAO Yinze;PAN Shengfa;XIA Tian;WANG Shaobo;SUN Yu(Department of Orthopaedics,Peking University Third Hospital,Engineering Research Center of Bone and Joint Precision Medicine,Beijing Key Laboratory of Spinal Disease Research,Beijing 100191;Department of Orthopaedics and Trauma,Jiangmen Wuyi Hospital of Traditional Chinese Medicine,Jiangmen 529000,Guangdong,China)

机构地区：[1]北京大学第三医院骨科,骨与关节精准医学教育部工程中心,脊柱疾病研究北京市重点实验室,北京100191 [2]广东省江门市五邑中医院骨伤科,广东江门529000

出　　处：《中华骨与关节外科杂志》2023年第4期347-354,共8页Chinese Journal of Bone and Joint Surgery

基　　金：首都卫生发展科研专项(首发2020-1-4092)。

摘　　要：目的:探讨经肌间隙入路和传统后正中入路对颈椎单开门椎管扩大椎板成形术治疗脊髓型颈椎病(CSM)围手术期加速康复外科(ERAS)进程的影响。方法:回顾性选取2021年3月至2022年9月行颈椎单开门椎管扩大椎板成形术的116例患者作为研究对象,将行经肌间隙入路颈椎单开门椎管扩大椎板成形术的58例患者列为经肌间隙入路组,行传统后正中入路颈椎单开门椎管扩大椎板成形术的58例患者列为后正中入路组。对比两组手术时间、留置引流管时间、下地时间、住院时间、术中出血量、术后第1日和第2日引流量、术后总引流量、手术前后白蛋白和血红蛋白水平变化、颈肩痛视觉模拟评分(VAS)、Barthel指数和脊髓功能改善率等。结果:经肌间隙入路组手术时间明显高于后正中入路组[(119.5±46.1)min vs.(68.1±11.4)min,P<0.05]。经肌间隙入路组留置引流管时间、下地时间、住院时间、术中出血量、术后第1日和第2日引流量、术后总引流量等均明显低于后正中入路组[(2.21±0.52)d vs.(4.14±1.05)d,(1.05±0.29)d vs.(1.83±0.82)d,(5.16±1.84)d vs.(6.17±1.26)d,(116.5±76.2)mL vs.(172.6±66.2)mL,(110.5±55.3)mL vs.(226.8±70.4)mL,(50.6±35.2)mL vs.(69.0±21.8)mL,(171.6±98.5)mL vs.(377.3±125.9)mL,均P<0.05]。经肌间隙入路组术后白蛋白水平降低值低于后正中入路组,但差异无统计学意义(P>0.05)。经肌间隙入路组术后血红蛋白水平降低值低于后正中入路组,差异有统计学意义(P<0.05)。经肌间隙入路组术后脊髓功能改善率、出院时Barthel指数与后正中入路组比较差异无统计学意义(P>0.05)。经肌间隙入路组术后颈肩痛VAS低于后正中入路组,差异有统计学意义(P<0.05)。结论:相较传统后正中入路,经肌间隙入路颈椎单开门椎管扩大椎板成形术有术中出血少、术后引流量少、留置引流管时间短、下地和出院时间早等优点,可以明显缩短围手术期ERAS�Objective:To investigate the difference between the transmuscular space approach and the conventional approach in the post-operative recovery process of cervical open door laminoplasty.Methods:Totally 116 patients underwent cervical open door laminoplasty between March 2021 and September 2022 were enrolled in this retrospective study.Patients with transmuscular space approach were listed as the transmuscular space approach group and patients with conventional approach were listed as the conventional approach group.The operation time,drainage indwelling time,ambulation time,hospital stay,intraoperative blood loss,postoperative day 1 and day 2 drainage volume,postoperative total drainage volume,decreased volume of albumin and hemoglobin after the surgery,the VAS score of postoperative neck and shoulder pain,Barthel index and improvement rate of spinal cord function were compared between the two groups.Results:The operation time in the transmuscular space approach group was significantly higher than that of the conventional approach group[(119.5±46.1)min vs.(68.1±11.4)min,P<0.05].The indwelling drainage time,ambulation time,hospital stay,intraoperative blood loss,postoperative day 1 and day 2 drainage volume,and total postoperative drainage volume were significantly lower in the transmuscular space approach group than in the conventional approach group[(2.21±0.52)d vs.(4.14±1.05)d,(1.05±0.29)d vs.(1.83±0.82)d,(5.16±1.84)d vs.(6.17±1.26)d,(116.5±76.2)mL vs.(172.6±66.2)mL,(110.5±55.3)mL vs.(226.8±70.4)mL,(50.6±35.2)mL vs.(69.0±21.8)mL,(171.6±98.5)mL vs.(377.3±125.9)mL,P<0.05].The postoperative albumin reduction was less in the transmuscular space approach group than in the conventional approach group with no statistically significant(P>0.05).Postoperative hemoglobin reduction was less in the transmuscular space approach group than in the conventional approach group with statistically significant(P<0.05).There was no statistical differences in the improvement rate of spinal cord function and Barthel ind

关 键 词：经肌间隙入路 颈椎单开门椎管扩大椎板成形术 加速康复外科 

分 类 号：R6[医药卫生—外科学]