老年病人腰椎后路减压术中不同切口缝合方法的临床效果比较

Effect of different incision sutures for posterior lumbar decompression in the elderly patients

目的评价不同缝合方式应用于老年病人腰椎后路减压融合内固定术切口的临床效果。方法选择需行腰椎后路减压融合内固定术的病人240例,随机分成2组,每组120例。A组用2-0丝线单纯间断缝合筋膜层、皮下组织以及表皮。B组采用鱼骨线单纯连续缝合筋膜层,倒刺线连续缝合皮下组织,钉皮钉闭合表皮。记录并比较2组病人年龄、体质量、皮下脂肪厚度、切口长度、术中切口缝合时间、术后切口引流量、术后切口愈合情况、术后全麻并发症发生率、术后住院时间及术后祛除敷料时间。结果2组年龄、体质量、术后住院时间及术后祛除敷料时间、切口脂肪液化及延迟愈合比例比较,差异无统计学意义(P>0.05);2组缝合时间,术后精神障碍(POP)、双下肢深静脉血栓(DVT)、术后切口感染及术后肺部感染比例差异有统计学意义(P<0.05)。排除术中脑脊液漏病人后,B组切口引流量少于A组(P<0.05);B组术中脑脊液漏病人较A组术后切口愈合时间缩短,差异具有统计学意义(P<0.05)。结论使用鱼骨线、倒刺线及钉皮钉缝合老年病人腰椎后路减压融合内固定术中切口能够有效缩短手术(麻醉)时间,从而降低POP、DVT、术后切口感染及术后肺部感染的发生率。同时,此种缝合方式还可显著减少术后切口引流量以及术中脑脊液漏病人术后切口愈合时间。

Objective To evaluate the clinical effect of two different suture methods in the lumbar posterior decompression fusion and internal fixation in the elderly patients.Methods A total of 240 patients who underwent posterior lumbar decompression fusion and internal fixation were randomly divided into 2 groups,with 120 cases in each group.In group A,the fascia layer,subcutaneous tissue and epidermis were sewn with 2-0 silk thread.In group B,fish bone thread was used to suture the fascia layer continuously,and the barb thread was used to suture the subcutaneous tissue continuously,and the skin nail was used to close the epidermis.The age,weight,subcutaneous fat thickness,incision length,intraoperative incision suture time,postoperative incision drainage,postoperative incision healing,incidence rate of postoperative complications,postoperative hospital stay and postoperative dressing removal time in the two groups were recorded and compared.Results There were no significant differences in age,weight,postoperative hospitalization time,postoperative dressing removal time,proportion of incision fat liquefaction and delayed healing between group A and group B(P>0.05).However,there were significant differences in suture time,proportion of postoperative mental disorder(POP),deep venous thrombosis(DVT)of both lower limbs,postoperative incision infection,postoperative pulmonary infection between group A and group B(P<0.05).After removal of the patients with intraoperative cerebrospinal fluid leakage,the incision drainage volume in group B was less than that in group A(P<0.05),while the postoperative wound healing time in the patients with intraoperative cerebrospinal fluid leakage in group B was shorter than that in group A(P<0.05).Conclusions The use of fish bone line,barbs line and skin nails to suture the incision of posterior lumbar decompression fusion and internal fixation in the elderly patients can effectively shorten the time of operation(anesthesia),thus reducing the incidence of POP,DVT of lower limbs,postoperative incision infection and postoperative pulmonary infection.At the same time,this method can significantly reduce the postoperative incision drainage and shorten the time of wound healing in the patients with intraoperative cerebrospinal fluid leakage.