罗哌卡因切口内浸润联合Wiltse入路在经椎间孔腰椎椎体间融合术中的应用效果

Application of ropivacaine incision infiltration combined with Wiltse approach in transforaminal lumbar interbody fusion

目的探讨罗哌卡因切口内浸润联合Wiltse入路在腰椎多节段减压融合内固定术镇痛中的应用及临床疗效。方法纳入南通大学第二附属医院2016年1月至2019年1月拟行腰椎后路多节段(≥2)单侧减压经椎间孔腰椎椎体间融合术(TLIF)的腰椎管狭窄症和(或)腰椎间盘突出症患者120例,随机分为4组,每组30例。A组采用罗哌卡因切口内浸润联合Wiltse入路TLIF,B组采用罗哌卡因切口内浸润联合后正中入路TLIF,C组采用生理盐水切口内浸润联合Wiltse入路TLIF,D组采用生理盐水切口内浸润联合后正中入路TLIF。比较4组患者的手术时间,术中出血量,术后引流量,术后镇痛药用量,术前及术后6 h、1 d、3 d、7 d、1个月、3个月腰背部疼痛视觉模拟量表(VAS)评分,以及术前及术后3 d、7 d、1个月、3个月Oswestry功能障碍指数(ODI)。结果4组患者性别、年龄、体重、手术节段、术前腰背部疼痛VAS评分、术前ODI差异均无统计学意义(P均>0.05)。A、C组患者术中出血量、术后引流量、术后镇痛药物用量均少于B、D组,差异均有统计学意义(P均<0.05)。术后6 h时A、B组VAS评分低于C、D组,术后3 d、7 d时A、C组VAS评分低于B、D组,术后3 d、3个月时A、C组ODI低于B、D组,差异均有统计学意义(P均<0.05)。结论罗哌卡因切口内浸润超前镇痛联合Wiltse入路应用于腰椎多节段减压融合内固定术镇痛效果显著,术后短期内腰背部疼痛减轻、功能恢复快,有利于患者术后早期康复。

Objective To explore the application and clinical effect of ropivacaine incision infiltration combined with Wiltse approach in the analgesia of lumbar multi-segment decompression and fusion internal fixation.Methods A total of 120 patients with lumbar spinal stenosis and(or)lumbar disc herniation,who received posterior lumbar multisegmental(≥2)transforaminal lumbar interbody fusion(TLIF)in the Second Affiliated Hospital of Nantong University from Jan.2016 to Jan.2019,were randomly assigned to four groups:group A(ropivacaine incision infiltration+Wiltse approach),group B(ropivacaine incision infiltration+posterior median approach),group C(saline incision infiltration+Wiltse approach)and group D(saline incision infiltration+posterior median approach).The operation time,intraoperative blood loss,postoperative drainage volume,postoperative analgesic dosage,the visual analogue scale(VAS)score of low back pain before operation and 6 h,1 d,3 d,7 d,1 month and 3 months after operation,and the Oswestry disability index(ODI)before operation and 3 d,7 d,1 month and 3 months after operation,were compared among the four groups.Results There were no significant differences in gender,age,body weight,operative segments,low back pain VAS score or ODI before operation(all P>0.05).The intraoperative blood loss,postoperative drainage volume and analgesic dosage were significantly lower in the groups A and C than those in the groups B and D(all P<0.05).The VAS scores 6 h after operation were significantly lower in the groups A and B than those in the groups C and D,and the VAS scores 3 and 7 d after operation were significantly lower in the groups A and C than the groups B and D(all P<0.05).The ODI values 3 d and 3 months after operation were significantly lower in the groups A and C than those in the groups B and D(all P<0.05).Conclusion Preemptive analgesia using ropivacaine incision infiltration combined with Wiltse approach in lumbar multisegment decompression and fusion internal fixation can effectively relieve postoperative pain,with remarkable analgesic effect and rapid functional recovery,benefiting early recovery of patients after operation.