肌层下引流对轻中度青少年特发性脊柱侧凸术后患者腰椎活动功能及Hb、Hct水平的影响

Effect of submuscular drainage on postoperative lumbar function and Hb and Hct levels in patients with mild to moderate adolescent idiopathicscoliosis

目的研究肌层下引流对轻中度青少年特发性脊柱侧凸(AIS)术后患者腰椎活动功能及血红蛋白(Hb)、红细胞压积(Hct)水平的影响。方法回顾性分析中山大学附属第一医院2012年6月至2017年9月收治的86例轻中度AIS术后患者的临床资料,根据是否放置引流管分为A组(肌层下引流组35例)、B组(未放置引流管组51例),两组患者术后均定期随访2年。比较两组患者手术相关指标,术前、术后当天、术后第3天及术后第7天全血血红蛋白(Hb)、红细胞压积(Hct)水平及术后2年腰椎活动度、功能/活动度。结果A组患者术后住院时间长于B组(P<0.05);两组患者发热持续时间、72 h热峰、术后输血患者占比及输红细胞悬液量比较,差异均无统计学意义(P>0.05);与术前比,术后当天至术后第7天两组患者全血Hb、Hct水平均呈现先降后升趋势,术后第3天A组患者的全血Hb、Hct水平低于B组(P<0.05);随访结果显示,两组患者腰椎活动度水平比较,差异无统计学意义(P>0.05);SRS-22量表中A组条目5评分高于B组(P<0.05);两组患者SRS-22量表其他相关条目评分比较,差异均无统计学意义(均P>0.05)。结论术后采用肌层下引流可改善轻中度AIS术后患者腰椎活动度及全血Hb、Hct水平,缩短发热持续时间,但显著延长了患者住院时间,而未放置引流管则可减少输红细胞悬液的使用量,降低术后输血患者比例,两者整体疗效相当。

Objective To investigate the effect of submuscular drainage on lumbar spinal function,hemoglobin(Hb)and hematopoiesis(Hct)in patients with mild to moderate adolescent idiopathic scoliosis(AIS).Methods A retrospective analysis of the clinical data of 86 patients with mild to moderate AIS who were admitted to The First Affiliated Hospital of Sun Yatsen University from June 2012 to September 2017,according to whether drainage was placed or not,they were divided into group A(35 cases in submuscular drainage group)and group B(51 cases in group without drainage tube).Patients in both groups were followed up for 2 years after surgery.The operative indicators of the two groups were compared,the whole blood hemoglobin(Hb),hematocrit(Hct)levels before operation and post-operation day,the 3rd d and the 7th d after operation,and 2 years after operation of lumbar activity,function/activity.Results The postoperative hospital stay in group A was longer than that in group B(P<0.05).Comparison of fever duration,72 h fever peak,postoperative blood transfusion ratio and erythrocyte transfusion suspension between the two groups,the difference was statistically insignificant(P>0.05);Compared with before operation,the whole blood Hb and Hct levels in both groups decreased then increased from post-operation day to the 7th d after operation,and group A was lower than group B at the 3rd d after operation(P<0.05).Followed up result showed that,there was no statistically significant difference in lumbar activity between the two groups(P>0.05).The item 5 score of group A in the SRS-22 scale was significantly higher than that of group B(P<0.05);Comparison of scores of other relevant items in the SRS-22 scale between the two groups,There was no statistically significant difference(all P>0.05).Conclusion Postoperative submuscular drainage can improve the lumbar spine mobility and the whole blood Hb and Hct levels in patients with mild to moderate AIS.It can shorten the duration of fever and reduce the 72 h heat peak,but it can prolong the hospital stay.The absence of drainage tube can reduce the amount of transfused red blood cell suspension and reduce the proportion of postoperative blood transfusion patients.The overall efficacy of the two groups was similar.