显微镜下单节段腰椎间盘切除术--引流放还是不放

Single-segment lumbar microdiscectomy:drainage or not

目的:评估显微镜下单节段腰椎间盘切除术不放置引流管的安全性和可行性。方法:对2018年1月至2019年8月选择显微镜下椎间盘切除术治疗的单节段腰椎间盘突出症135例患者进行回顾性分析,其中男95例,女40例;年龄18~40(28.3±5.4)岁。根据术后是否放置引流管分为引流管组(78例)和无引流管组(57例)。记录年龄、性别、手术节段、体质量指数、症状持续时间、随访时间、手术时间、术中出血量、下地时间、住院时间、引流组术后拔除时间及引流量、术后体温。比较术后第1、3天仰卧静息状态下切口疼痛视觉模拟评分(visual analogue scale,VAS),术前及术后3 d,1、3个月下地活动时腰痛及下肢放射痛VAS。观察术前,术后1、3个月时Oswestry功能障碍指数(Oswestry Disability Index,ODI)。计算症状性切口血肿、切口愈合不良、切口感染、神经功能障碍加重及进行性变化、非计划二次手术等并发症的比率。结果:两组患者的年龄、性别、手术节段、体质量指数、症状持续时间、随访时间、手术时间、术中出血量、术后体温差异无统计学意义。住院时间和下地时间无引流组短于引流组(P=0.0000)。无引流组在术后第1、3天切口疼痛VAS评分优于对照组(P<0.05)。术后不同时间患者腰痛VAS和ODI较术前明显减轻。两组病例均未出现症状性血肿;术后神经功能障碍即刻加重两组各出现1例,均表现为感觉障碍加重,无神经功能进行性加重,经观察后感觉障碍恢复;切口感染两组各出现1例,均经药物治疗治愈;切口愈合不良两组各出现1例,均经反复换药后愈合。引流组非计划二次手术出现1例,患者由于1个月内突出复发,而行二次手术治疗。结论:显微镜下单节段腰椎间盘切除术不放置引流,在严格止血和保护组织的前提下,可以缩短平均住院日,早期下地活动,减少了放置引流的创伤刺激,是腰椎间盘突出症患者手术加速康复中一个可以选择的措施。

Objective:To evaluate the safety and feasibility of single-segment lumbar microdiscectomy without drainage.Methods:The clinical data of 135 patients with single-segment lumbar disc herniation treated by microdiscectomy surgery from January 2018 to August 2019 were retrospectively analyzed.There were 95 males and 40 females,aged from 18 to 40 years old,with a mean of(28.3±5.4)years.They were divided into drainage group(78 cases)and non-drainage group(57 cases)according to whether the drainage tube was placed during operation.The general conditions of patients were recorded such as age,gender,operation segment,body mass index(BMI),symptom duration,follow-up time,operation time,intraoperative blood loss,out-of-bed time,hospital stay,postoperative drainage removal time and drainage volume of drainage group,postoperative body temperature.VAS of incisional pain in supine resting state on the 1 and 3 days after operation,the VAS of low back pain and lower extremity radiating pain during ground exercise before operation,3 days,1 month and 3 months after operation were compared.Oswestry Disability Index(ODI)was collected before operation,1 month and 3 months after operation.The ratio of complications was calculated such as symptomatic incision hematoma,poor incision healing,incision infection,exacerbation and progressive aggravation of neurological dysfunction,and unplanned secondary surgery.Results:There were no significant differences in age,gender,operation segment,BMI,symptom duration,follow-up time,operation time,intraoperative blood loss,and postoperative body temperature between two groups.The average hospital stay and out-of-bed time in non-drainage group were shorter than in drainage group(P=0.0000).VAS of incision pain in non-drainage group was lower than that in control group at 1 and 3 days after surgery(P<0.05).Postoperative low back pain VAS and ODI of all patients were significantly reduced compared with those before surgery.No symptomatic hematoma occurred in two groups.Postoperative neurological dysfunction immediately aggravated each one patient in two groups,and no progressive aggravation of neurological function was found in two groups.Incision infection occurred in one case in each of the two groups,and both were cured by drug treatment;poor incision healing occurred in one case in each of the two groups,and both were healed after repeated dressing changes.There was one case of unplanned second operation in drainage group,the patient received a second operation due to disc protrusion recurrence within 1 month.Conclusion:Single-segment lumbar microdiscectomy without drainage can shorten the average hospital stay and promote early exercise out of bed,and reduce the trauma and stress reaction of drainage.No drainage may be an option for patients with enhanced recovery after lumbar microdiscectomy.