骶棘肌复位缝合在保留棘突腰椎后路手术中的应用

Suture with sacrospinal muscle reposition in posterior lumbar surgery without removal of spinous process

目的通过与传统的骶棘肌游离法进行比较，探讨骶棘肌复位缝合法在腰椎后路手术中的应用效果。方法2005年7月至2010年7月对303例患者行保留棘突腰椎后路手术，男181例，女122例；年龄18～82岁，平均38．6岁；按疾病类型、手术方式及骨折节段分别采用：腰椎间盘突出症单纯椎板间隙开窗髓核摘除、腰椎间盘突出症半椎板切除髓核完全摘除椎间植骨融合内固定、单一节段骨折固定及2个节段骨折固定4种方法治疗。对所有患者的切口关闭随机采用2种方法：骶棘肌复位缝合法（骶棘肌复位组158例）和骶棘肌游离法（骶棘肌游离组145例）。记录患者术后24、48h内引流血量、切口愈合不良发生数及拆线时间，根据手术前、后血红蛋白检测结果计算患者血红蛋白的丢失率，并对两组数据进行比较。结果骶棘肌复位组24、48h切口引流血量低于骶棘肌游离组，差异均有统计学意义（P〈0．05）；腰椎间盘突出症行单纯髓核摘除术、单一节段骨折、2个节段骨折的骶棘肌复位组的48h血红蛋白丢失率低于骶棘肌游离组，差异均有统计学意义（P〈0．05）；骶棘肌复位组的切口愈合不良发生率低于骶棘肌游离组，差异有统计学意义（P〈0．05）。拆线时间两组差异均无统计学意义（P〉0．05）。结论在保留棘突的腰椎后路手术切口缝合中，与骶棘肌游离法比较，采用骶棘肌复位缝合法能明显减少术后引流量、切口愈合不良等发生率，是一种良好的缝合方法。

Objective To compare the clinical outcomes of suture with sacrospinal muscle reposition and conventional suture with sacrospinal muscle floating in posterior lumbar surgery without removal of the spinous process. Methods Between July 2005 and July 2010, 303 patients underwent posterior lumbar operations without removal of the spinous process. They were 181 men and 122 women, aged from 18 to 82 years （mean, 38.6 years） . The 2 methods of suture were randomly adopted for the patients in the surgery. Suture with sacrospinal muscle reposition was used in 158 cases and conventional suture with sacrospinal muscle floating in 145 cases. The drainage volumes at 24 and 48 hours after operation, malunion rates, and time for removal of stitches were recorded and loss of hemoglobin was calculated according to the hemoglobin counts before and after operation. All the data were statistically analyzed using SPSS11.0 software to compare the effects of the 2 suture methods. Results There were significant differences between the 2 sutures in drainage volumes at 24 and 48 hours after operation, hemoglobin loss at 48 hours after operation in most cases, and malunion rate （P 〈 0. 05）, indicating the reposition suture was superior to the floating suture. There was no significant difference in time for removal of stitches between the 2 methods（ P 〉 0.05） . Conclusion In posterior lumbar surgery not to remove the spinous process, suture with sacrospinal muscle reposition may be superior to the conventional suture with sacrospinal muscle floating.