加速康复外科模式在经皮椎间孔镜腰椎间盘摘除术中的应用

Application of enhanced recovery after surgery pattern in percutaneous transforarminal endoscopic discectomy

目的分析加速康复外科(ERAS)模式在经皮椎间孔镜腰椎间盘摘除术的应用效果。方法选取2018~2020年在我院行经皮椎间孔镜腰椎间盘摘除术患者77例,按随机原则分为两组。加速康复组39例,采用加速康复外科模式管理;传统康复组38例,采用传统康复模式管理。两组术后随访10~48个月,平均20.05个月。分析比较两组患者的手术时间、出血量、术后卧床时间、住院时间以及术前和术后3 d、术后3个月及末次随访时的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、手术并发症发生情况。结果两组患者术后的VAS、ODI与术前比较均有明显改善,差异均有统计学意义(均P<0.05);加速康复组患者术后第3天的VAS、ODI均低于传统康复组,差异均有统计学意义(均P<0.05);术后3个月及末次随访时,两组患者的VAS、ODI比较差异均无统计学意义(均P>0.05)。加速康复组的手术时间更短、出血量更少、术后卧床时间和住院时间均显著少于传统康复组,差异均有统计学意义(均P<0.05)。两组患者的并发症发生率比较,加速康复组为2.56%,传统康复组为5.26%,组间比较差异无统计学意义(P>0.05)。结论加速康复外科模式用于经皮椎间孔镜腰椎间盘切除术的效果优于传统康复模式,能减轻术后疼痛程度,缩短手术时间和住院时间,促进了患者术后康复。

Objective To analysis the effect of enhanced recovery after surgery(ERAS)pattern in percutaneous transforarminal endoscopic discectomy.Methods From 2018 to 2020,77 patients with lumbar disc herniation underwent percutaneous transforarminal endoscopic discectomy whom were set to ERAS group(n=39)and traditional recovery group(n=38)according to the random rude.The ERAS group was managed with the enhanced recovery after surgery pattern,but the traditional recovery group was managed with the traditional recovery pattern.All patients received follow-ups 10-48 months with an average of 20.05 months.The comparative analysis included operation time,amount of bleeding,postoperative bed time,hospital days,the VAS and ODI before and 3-days after surgery,3-monthes after surgery,the last follow-up time,and the surgical complications.Results The postoperative VAS and ODI were obviously improved in these two groups,with statistically significant difference(P<0.05 for each).The 3-days postoperative VAS and ODI of the ERAS group were below the traditional recovery group,which was statistically significant(P<0.05 for each).The VAS and ODI were similar in 3-months postoperative the and the last follow-up of these two groups,which was not statistically significant(P>0.05).The ERAS group had shorter surgical time and less bleeding volume,postoperative bed time and the hospitalization time and were significantly shorter than the traditional recovery group too,which was statistical significance(P<0.05 for each).Complication rates were similar in the two groups,with 2.56%in the ERAS group and 5.26%in the traditional recovery group,which was not statistical significance(P>0.05).Conclusion Using the concept of enhanced recovery after surgery in percutaneous transforarminal endoscopic discectomy can achieve a better effect than the traditional recovery,and the former had less surgical time,less bloody lost,less postoperative bed time and hospitalization time,and faster recovery.