经皮椎弓根螺钉取内固定术中钉道处理对术后出血影响的研究

Impact of Nail Channel Treatment on Postoperative Hemorrhage in Fixation Removal of Percutaneous Pedicle Screw

目的:探讨经皮椎弓根螺钉取内固定术中是否使用预制锥形可吸收性明胶海绵填塞取出椎弓根螺钉钉道对术后局部出血的影响。方法:2020年6月到2023年1月时间内,我院对符合纳入及排除标准的经皮椎弓根螺钉术后进行内固定去除患者共计68例纳入研究。随机分为两组,观察组取出椎弓根螺钉后填塞预制锥形可吸收性明胶海绵,对照组仅进行生理盐水冲洗后空置处理。统计和比较患者术前、术后3天的血液实验室指标、术后切口疼痛及功能评分以及相应的影像学检查。结果:观察组患者中,术前、术后3天血常规结果比较无明显统计学差异(P>0.05),实验组在术后3天炎症因子结果显著好于对照组(P<0.05);术后2天换药时,实验组在局部肿胀程度以及B超下估测出血量等指标的比较中,均显著优于对照组(P<0.05),两组患者在术前、术后1天的VAS评分、ODI评分的比较中无统计学差异(P>0.05),但在术后5天的比较中,实验组显著优于对照组(P<0.05)。所有患者均未出现不可挽救的并发症。结论:经皮椎弓根螺钉术后原切口取内固定术后,钉道内填塞预制锥形可吸收明胶海绵能够明显减少术后出血,减轻患者痛苦,缩短住院时间,是一种理想的治疗方式,在该类手术中可以推广常规应用。

Objective:Exploring the effect of using prefabricated conical absorbable gelatin sponge to fill and remove pedicle screw paths during percutaneous pedicle screw removal and internal fixation surgery on postoperative local bleeding.Methods:From June 2020 to January 2023,our hospital included a total of 68 patients who met the inclusion and exclusion criteria for internal fixation removal after percutaneous pedicle screw surgery.Randomly divided into two groups,the observation group was filled with prefabricated conical absorbable gelatin sponge after removing the pedicle screws,while the control group was only treated with saline irrigation and then left empty.Collect and compare blood laboratory indicators,postoperative incision pain and functional scores,and corresponding imaging examinations of patients before and 3 days after surgery.Results:In the observation group,there was no significant statistical difference in blood routine results between preoperative and postoperative 3 days(P>0.05).The experimental group had significantly better inflammatory factor results than the control group on postoperative 3 days(P<0.05);At the time of dressing change 2 days after surgery,the experimental group was significantly better than the control group in terms of local swelling degree and estimated bleeding volume under ultrasound(P<0.05).There was no statistically significant difference in VAS score and ODI score between the two groups before surgery and 1 day after surgery(P>0.05),but in the comparison 5 days after surgery,the experimental group was significantly better than the control group(P<0.05).All patients did not experience irreparable complications.Conclusion:After percutaneous pedicle screw surgery,the original incision is taken out for internal fixation.Prefabricated conical absorbable gelatin sponge is used to fill the screw path,which can significantly reduce postoperative bleeding,alleviate patient pain,and shorten hospital stay.It is an ideal treatment method and can be promoted for routine application in this type of surgery.