自动拉钩对传统腰椎后路手术疗效影响的临床研究

Clinical Study of the Influence of Automatic Retractors in Conventional Posterior Lumbar Surgery

目的研究自动拉钩对传统腰椎后路手术疗效的影响。方法自2013年1月-2014年4月行传统腰椎后路手术治疗的各种腰椎疾病患者43例,随机分为两组,20例术中使用自动拉钩,23例患者未使用自动拉钩,比较围手术期参数、术后肌酸激酶的变化、视觉模拟评分（visual analogue scale,VAS）。结果两组比较手术时间、术中出血量、住院天数无明显差异（P〉0.05）,但术后24 h、术后半年的腰痛VAS评分使用自动拉钩组高于未使用自动拉钩组（P〈0.05）,术后肌酸激酶水平使用自动拉钩组明显高于未使用自动拉钩组（P〈0.05）。结论自动拉钩的使用加重了椎旁肌损伤,从而导致患者术后腰痛较重,降低了手术本身应有的疗效。

Objective To study the influence of automatic retractors in conventional posterior lumbar surgery. Methods 43 cases treated with posterior lumbar surgery from January 2013 to April 2014 were divided randomly into two groups. Automatic retractors were used in 20 patients to open the posterior lumbar incision,and common smooth plate hooks were used in the other 23 patients. Perioperative parameters,postoperative changes of creatine kinase and visual analogue scale（ VAS） were compared between the two groups. Results There was no significant difference of the operative time,intraoperative bleeding,and the hospital stay. But the 24-hour and half-year VAS after operation was significantly higher in the automatic retractor group. Also the postoperative creatine kinase levels in automatic retractor group were significantly higher than that of the common hook group. Conclusion The use of automatic retractor would exacerbate paraspinal muscle injury,leading to low back pain in the postoperative patients,and reducing the efficacy of the surgery itself should be.