短节段腰椎融合后引流时间与早期疗效的关系  

Relationship between drainage time and early efficacy after short-segment lumbar fusion

作　　者：陈赞 雷飞 叶飞 周庆忠 袁浩 郑礼鹏 查娴 冯大雄 Chen Zan;Lei Fei;Ye Fei;Zhou Qingzhong;Yuan Hao;Zheng Lipeng;Zha Xian;Feng Daxiong(Department of Orthopedics,Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan Province,China)

机构地区：[1]西南医科大学附属医院骨科,四川省泸州市646000

出　　处：《中国组织工程研究》2024年第6期927-933,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:引流管作为腰椎术后常规方式方便术后出血引流及管理,目前对于风险较小的短节段腰椎术后拔管时间选择仍未达成共识。目的:探讨短节段腰椎融合后不同引流时间对早期临床疗效的影响。方法:对西南医科大学附属医院2017年3月至2021年4月因腰椎退行性疾病行经后路椎体间融合的220例患者进行前瞻性随机对照研究,随机分为术后第2天拔管组(A组)、术后第3天拔管组(B组)、观察法24 h引流量<30 mL后拔管组(C组)。观察比较3组患者围术期指标及随访结果。结果与结论:(1)因患者失访7例,排除2例,最终纳入211例,其中A组72例,B组71例,C组68例;(2)C组平均引流时间2.91 d;3组间术后引流量A组明显少于B、C组,差异有显著性意义(P<0.05);术后第3天红细胞压积值C组低于A、B组,差异有显著性意义(P<0.05);术后下床活动及住院时间A组短于B、C两组,差异有显著性意义(P<0.05);(3)A组4例、B组2例、C组3例患者接受同种异体输血,组间相比差异无显著性意义(P>0.05);(4)术后并发症方面,3组术后伤口渗漏及手术部位感染情况相比,差异无显著性意义(P>0.05);(5)所有患者均获12个月以上随访,3组患者术后出院前及末次随访目测类比评分、Oswestry功能障碍指数均较术前明显改善(P<0.05),组间比较差异均无显著性意义(P>0.05);(6)提示腰椎后路椎体间融合术后第2天拔除引流管可有效减少下床活动时间和住院时间,不增加术后失血量及并发症风险。BACKGROUND:As a routine method after lumbar spine surgery,a drainage tube is convenient for postoperative bleeding drainage and management,and there is still no consensus on the choice of postoperative removal time for short-segment lumbar spine surgery with less risk.OBJECTIVE:To explore the effect of different drainage times on early clinical efficacy after short-segment lumbar fusion.METHODS:A prospective randomized controlled study was performed on 220 patients in the Affiliated Hospital of Southwest Medical University who underwent posterior lumbar interbody fusion for lumbar degenerative diseases from March 2017 to April 2021.According to the different drainage times,the patients were randomly divided into removal on the second day after operation(group A),removal on the third day after operation(group B),and removal after the observation method 24-hour drainage volume<30 mL(group C).The perioperative indicators and follow-up results of the three groups of patients were observed and compared.RESULTS AND CONCLUSION:(1)Because 7 patients were lost to follow-up,2 patients were excluded,and 211 patients were finally included(72 patients in group A,71 patients in group B,and 68 patients in group C).(2)The average drainage time of group C was 2.91 days.The postoperative drainage volume in group A was significantly less than that in groups B and C,and the difference was statistically significant(P<0.05).On day 3 after operation,the hematocrit value of group C was lower than that of group A and group B,and the difference was statistically significant(P<0.05).Postoperative activity time and hospital stay in group A were shorter than those in groups B and C,and the difference was statistically significant(P<0.05).(3)Four patients in group A,two patients in group B and three patients in group C received an allogeneic blood transfusion.There was no significant difference among the groups(P>0.05).(4)In terms of postoperative complications,there were no statistical differences in postoperative wound leakage and surgical

关 键 词：腰椎融合术 引流 引流管拔除 术后恢复 输血 伤口渗漏 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R681.57