颈后路单开门椎管扩大成形术后即刻保持常压引流与负压引流效果的比较  

Comparison of Effects of Immediate Normal Pressure Drainage and Negative Pressure Drainage After Posterior Cervical Expansive Open-door Laminoplasty

作　　者：高阳[1] 王勇[1] 刘阳[1] 杨枭雄 吴坤 Gao Yang;Wang Yong;Liu Yang(Department of Orthopedics,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科,北京100191

出　　处：《中国微创外科杂志》2024年第8期553-557,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨颈后路单开门椎管扩大成形(expansive open-door laminoplasty,EOL)术后即刻保持常压引流的临床效果。方法回顾性分析2023年1~6月我院94例多节段脊髓型颈椎病行颈后路EOL,按入院时间顺序分为常压引流组(n=43)和负压引流组(n=51),常压组病例时间为2023年1~3月,负压组为2023年4~6月。比较2组术中出血量、术后24 h引流量、术后总引流量、术后引流管留置时间、术后发热、切口感染、颈部切口血肿、手术前后日本骨科学会(Japanese Orthopaedics Association,JOA)评分改善率、住院时间、住院费用、术后血红蛋白下降值等。结果常压引流组术后24 h引流量中位数45(15~150)ml,显著少于负压引流组中位数170(70~400)ml(Z=-7.934,P=0.000);常压引流组术后总引流量中位数45(15~285)ml,显著少于负压引流组中位数315(165~730)ml(Z=-7.924,P=0.000);常压引流组术后引流管留置时间(27.1±13.9)h,明显短于负压引流组(82.2±20.6)h(t=-14.933,P=0.000);常压引流组住院时间(3.5±1.1)d,明显短于负压引流组(5.6±0.8)d(t=-10.322,P=0.000);常压引流组术后血红蛋白下降(13.9±3.1)g/L,显著低于负压引流组(16.5±7.2)g/L(t=-2.165,P=0.033);常压引流组住院费用(3.00±0.30)万元,显著少于负压引流组(3.48±0.29)万元(t=-7.924,P=0.000)。2组术中出血量、术后发热、切口感染发生率无显著性差异(P>0.05)。2组均无深部切口感染或血肿发生。2组术后3个月JOA评分改善率无显著性差异(t=0.861,P=0.391)。结论颈后路EOL术后常压引流可以减少术后引流量,缩短引流管留置时间和住院时间,降低患者住院费用,且并不增加术后血肿、发热及切口感染等并发症,临床效果显著。Objective To investigate the clinical effect of normal pressure drainage immediately after posterior cervical expansive open-door laminoplasty(EOL).Methods A retrospective analysis was performed on 94 cases of posterior cervical EOL in our hospital from January 2023 to June 2023.The patients were divided into normal pressure drainage group(n=43)and negative pressure drainage group(n=51)according to the order of admission time.The time range of cases in the normal pressure group was from January to March 2023,while in the negative pressure group was from April to June 2023.The 24 h postoperative drainage volume,total postoperative drainage volume,drainage tube indwelling time,postoperative fever,incision infection,neck wound hematoma,Japanese Orthopaedics Association(JOA)score improvement rate before and after surgery,length of hospital stay,hospital cost and postoperative hemoglobin decline were compared between the two groups.Results The 24 h postoperative drainage volume of the normal pressure drainage group was significantly lower than that of the negative pressure drainage group[45(15-150)ml vs.170(70-400)ml,Z=-7.934,P=0.000].The total drainage volume in the normal pressure drainage group was significantly lower than that in the negative pressure drainage group[45(15-285)ml vs.315(165-730)ml,Z=-7.924,P=0.000].The drainage tube indwelling time was(27.1±13.9)h in the normal pressure drainage group and(82.2±20.6)h in the negative pressure drainage group,with statistically significant difference between the two groups(t=-14.933,P=0.000).The length of hospital stay was(3.5±1.1)d in the normal pressure drainage group and(5.6±0.8)d in the negative pressure drainage group,with statistical significance between the two groups(t=-10.322,P=0.000).The postoperative hemoglobin decline was(13.9±3.1)g/L in the normal pressure drainage group and(16.5±7.2)g/L in the negative pressure drainage group,with statistically significant difference between the two groups(t=-2.165,P=0.033).The hospitalization cost was(3.00±0.30)t

关 键 词：颈后路手术 单开门椎管扩大成形术 常压引流 负压引流 血肿 

分 类 号：R687.3[医药卫生—骨科学]