ERAS在经椎间孔腰椎间融合术治疗单节段腰椎退变性疾病中的应用

Application of enhanced recovery after surgery in single-segment transforaminal interbody fusion in the treatment of degenerative disease of the lumbar spine

目的研究加速康复外科(ERAS)在经椎间孔腰椎间融合术(TLIF)治疗腰椎退变性疾病中的应用效果。方法回顾性分析2019年1月至2020年6月50例行腰椎单节段经椎间孔椎间融合术的患者,其中25例实施ERAS管理(ERAS组),25例实施传统围术期管理(对照组)。比较两组患者住院时间,手术前后血红蛋白、CRP,术中出血量,术后1 d引流量,采用视觉疼痛模拟评分法(VAS)评估围术期疼痛情况,采用腰椎JOA评分评估手术前后功能改善情况。结果两组患者术前一般资料、VAS评分、JOA评分差异均无统计学意义(P>0.05)。ERAS组住院时间、术后血红蛋白、CRP、术中出血量、术后1 d引流量均低于对照组,差异有统计学意义(P<0.05)。ERAS组术后1、2、3 d VAS均优于对照组,差异有统计学意义(P<0.05),两组间术后JOA评分差异无统计学意义(P>0.05)。结论在单节段经椎间孔融合术围术期采用ERAS管理可有效减少术中及术后血液丢失,缩短患者住院时间,减轻患者术后疼痛。

Objective To investigate the effects of enhanced recovery after surgery(ERAS)in single-segment transforaminal lumbar interbody fusion(TLIF)in the treatment of degenerative disease of the lumbar spine.Methods A retrospective study was carried out from January 2019 to June 2020 on 50 patients who underwent single-segment transforaminal lumbar interbody fusion,among whom 25 patients received ERAS intervention(ERAS group)and 25 patients received routine intervention(control group).The length of stay,preoperative hemoglobin,CRP,blood loss,and 24-hour postoperative drainage were recorded.Perioperative pain was assessed by visual analogue scale(VAS)and lumbar JOA score was used to assess spinal function before and after surgery.Results There were no significant differences in preoperative general data,operation time,VAS score and JOA score between the two groups(P>0.05).Length of stay,postoperative hemoglobin,postoperative CRP,blood loss,24-hour postoperative drainage in ERAS group were lower than those in the control group with statistical significance(P<0.05).The ERAS group had lower postoperative VAS than the control group with statistical significance(P<0.05).There were no significant differences in JOA score before and after surgery between the two groups(P>0.05).Conclusion ERAS decreases blood loss,length of stay,postoperative pain and improves postoperative lumbar function in single-segment transforaminal lumbar interbody fusion.