单节段微创经椎间孔腰椎体间融合术后放置引流管必要性的研究

Essentiality research of drainage tube in minimally invasive single-level transforaminal lumbar interbody fusion

[目的]观察微创经椎间孔腰椎体间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗单节段腰椎退行性疾病的术中出血量、术后引流量和引流管放置时间等指标,探讨术后放置引流管的意义及必要性。[方法]回顾性分析本院2007年1月～2011年1月收治的112例单节段腰椎退行性疾病患者,其中52例行切开TLIF手术(Open-TLIF)并放置引流管,28例行MIS-TLIF手术并放置引流管,32例行MIS-TLIF手术但不放置引流管,观察术中出血量、术后引流量、引流管放置时间及并发症情况等指标,最后比较三组临床结果。[结果]Open组平均术中出血量(381±96)ml,术后引流量(324±146)ml,引流管放置时间(3.0±0.8)d;MIS引流组平均术中出血量(78±34)ml,术后引流量(46±15)ml,引流管放置时间(1.1±0.3)d;MIS不引流组平均术中出血量(81±30)ml。三组间比较伤口感染、血肿压迫等并发症发生情况无统计学差异(P>0.05)。MIS引流组与不引流组术中出血量、并发症均无统计学差异(P>0.05),但不引流组术后5 d腰痛VAS评分优于引流组(P<0.05),术后平均下地时间和住院日均短于引流组(P<0.05)。[结论]在术中止血彻底的前提下,单节段腰椎MIS-TLIF手术可以不放置引流管。

[ Objective] To observe perioperative parameters of minimally invasive （MIS） transforaminal lumbar interbody fusion （TLIF） for single -level lumbar disc disease and to investigate the significance and essentiality of drainage tube in MIS - TLIF for single -level lumbar disc disease. [Methods] From Jan 2007 to Jan 2011, 112 patients with single -level disc disease were enroled in this study, among them 52 patients underwent Open - TLIF with drainage, 28 patients underwent MIS - TLIF with drainage and 32 patients underwent MIS - TLIF without drainage. The results of perioperative parameters were observed, including pereoperative blood loss, postoperative ambulation and standing time of drainage tube. The clinical results of three groups were compared. [Results] The average operative blood loss was （381 ±96） ml and postoperative blood loss was （324 ± 146） ml in open group. The average operative blood loss was （78 ± 34） ml and postoperative blood loss was （46 ± 15 ） ml in MIS with drainage group, and the average operative blood loss was （81 ±30） ml in MIS without drainage group. The average standing time of drainage tube was （3.0 ± 0. 8） d in open group and was （ 1.1 ± 0. 3） d in MIS with drainage group. The statistics difference couldn＇ t be found in pereoperative blood loss and incidence rate of complications between group with drainage and group without drainage in MIS group （P 〉 0. 05）, but the back pain VAS score of group without drainage in postoperative 5 days were better than of group with drainage （P 〈 O. 05）, and there were less ambulation time and hospitalization time in group without drainage （P 〈 0. 05 ） . [ Conclusion] Drainage tube is not necessary in singlelevel MISTLIF with hemostasis.