多节段经椎间孔椎体间融合三种引流方式比较△

Comparison of three drainage methods after multi-segment transforaminal lumbar interbody fusion

摘要:

[目的] 比较多节段经椎间孔椎体间融合 (transforaminal lumbar interbody fusion, TLIF) 3 种引流方式临床疗效。[方法]2019 年 7 月—2021 年 6 月在本科行 TLIF 治疗的多节段腰椎退变 104 例患者采用随机数字表法分为三组，于 TLIF 术后分别给予 3 种引流，其中，34 例行间断负压引流，37 例行持续负压引流，33 例行常压引流。比较三组早期及随访结果。[结果]所有患者均顺利完成手术，三组手术时间、术中出血量差异无统计学意义(P＞0.05)，持续负压组第 1 d 和术后总引流量，以及引流管留置时间显著大于其他两组(P＜0.05)；常压组伤口敷料渗血次数显著多于其他两组(P＜0.05)。随时间推移。三组患者腿痛 VAS 评分、ODI 评分、JOA 评分均显著改善(P＜0.05)，相应时间点，三组间上述评分的差异均无统计学意义(P＞0.05)。[结论]多节段 TLIF 术后采用间断负压引流可以明显减少引流量和伤口渗血，缩短引流时间，是一种安全有效的方式。

Abstract:

[Objective] To compare the clinical efficacy of three drainage methods after multi-segment transforaminal lumbar interbody fusion (TLIF). [Methods] From July 2019 to June 2020, a total of 104 patients who were undergoing TLIF for multilevel lumbar degenerative diseases in our department were divided into 3 group. After TLIF, 34 patients had intermittent negative pressure drainage (INPD), 37 pa- tients received continuous negative pressure drainage (CNPD), while the remaining 33 patients were treated by natural pressure drainage (NPD). The perioperative and follow-up data of the three groups were compared. [Results] All the patients in the 3 groups had TLIF per- formed smoothly. Although there were no significant differences in operative time and intraoperative blood loss among three groups (P＞0.05), the CNPD group proved significantly greater than the INPD and NPD groups in terms of drainage volume at the 1st postoperative day, total vol- ume of postoperative drainage and total drainage days (P＜0.05). However, the NPD group had significantly greater incision errhysis than the INPD and CNPD groups (P＜0.05). The VAS of leg pain and ODI significantly decreased (P＜0.05), while the JOA scores significantly in- creased over time postoperatively in all the 3 groups (P＜0.05), whereas which proved not statistically significantly among the 3 groups at any corresponding time points (P＞0.05). [Conclusion]The intermittent negative pressure drainage after multilevel TLIF does significantly re- duce the drainage volume, reduce postoperative wound bleeding, and shorten total drainage days, is a safe and effective drainage method.