经皮脊柱内镜腰椎间盘切除术后留置引流疗效观察

Clinical outcomes of indwelling drainage after percutaneous endoscopic lumbar discectomy

背景术后留置引流有利于减轻局部血肿、减小切口张力、缓解术后疼痛、加快术后康复等,但同时也存在着增加伤口感染概率等风险。对于经皮脊柱内镜腰椎间盘切除术后是否需放置引流尚无相关文献报道。目的分析脊柱内镜术后留置引流管的临床疗效,为进一步完善手术流程和术后康复方案提供数据支持。方法收集2018年11月-2020年12月解放军总医院海南医院骨科收治的140例单纯腰椎间盘突出症行脊柱内窥镜手术治疗患者的临床资料。按是否进行引流分为引流组和非引流组,观察分析两组术后感染率、术后血肿形成率、术前与术后疼痛视觉模拟评分(visual analog scale,VAS)。结果引流组70例,男性54例,女性16例,平均年龄(46.83±16.31)岁;非引流组70例,男性45例,女性25例,平均年龄(47.6±17.46)岁。140例患者均获得3个月随访。两组术后1周VAS评分,非引流组显著高于引流组(P<0.05)。术后15 d、术后3个月VAS评分,两组差异无统计学意义(P>0.05)。术后随访非引流组有1例出现术后血肿,引流组无血肿形成病例。两组均无术后感染病例。结论脊柱内镜术后留置引流对于降低患者术后血肿形成和减轻术后疼痛有一定作用。

Background Postoperative indwelling drainage is beneficial to alleviate local hematoma,reduce incision tension,relieve postoperative pain,and speed up recovery,however,it also increases the risk of wound infection.There is no literature report on whether drainage should be placed after percutaneous endoscopic lumbar discectomy.Objective To compare the clinical effect of indwelling drainage after percutaneous endoscopic lumbar discectomy,and provide data support for the improvement of surgical procedures and the formulation of postoperative rehabilitation programs.Methods A retrospective analysis was performed on 140 patients who underwent spinal endoscopic surgery in the department of orthopaedics of our hospital from November 2018 to December 2020.The patients were divided into two groups according the drainage.The differences in postoperative infection rate,postoperative hematoma formation rate,preoperative and postoperative visual analogue scale(VAS)were observed and statistically analyzed.Results There were 70 cases in with postoperative drainage group,with 54 males and 16 females,average age of(46.83±16.31)years,and 70 cases were in without postoperative drainage group,with 45 males and 25 females,average age of(47.60±17.46)years.All patients were followed up for 3 months.The postoperative VAS score of the drainage group was significantly lower than that of the non-drainage group(P<0.05),however,there were no significant differences in the VAS score of preoperative,15d after operation and 3 months after operation(all P>0.05).During the postoperative follow-up,there was 1 case of postoperative hematoma in the non-drainage group,no hematoma formation was found in the drainage group,and no postoperative infection occurred in the two groups.Conclusion The indwelling drainage after percutaneous endoscopic lumbar discectomy is helpful in reducing the formation of postoperative hematoma and alleviating postoperative pain.