特发性脊柱侧凸后路矫形术后两种引流方式的对比观察

Clinical comparative analysis of two different post-surgery drainages in idiopathic scoliosis patients

中文关键词:  特发性脊柱侧凸  皮下引流  肌层下引流  后路矫形术

英文关键词:Idiopathic scoliosis  Subcutaneous closed suction drainage  Submuscular closed suction drainage  Posterior correction

中文摘要:

  【摘要】 目的：观察特发性脊柱侧凸患者后路矫形术后皮下引流与肌层下引流情况，比较两种引流方式的效果。方法：2005年2月~2007年9月在我院行后路脊柱侧凸矫形同种异体骨植骨融合内固定术患者89例，其中放置皮下引流组（A组）42例，放置肌层下引流组（B组）47例。收集两组患者围手术期数据，包括人口统计学资料（年龄、性别、身高、体重及身体质量指数）、术前侧凸分型与主弯Cobb角、术中资料（手术时间、估计失血量、自体血回输量、输异体红细胞悬液及术中融合节段）、术后切口引流量、术后输血量、术后发热时间与72h体温峰值、术后置管时间及出院时切口愈合等级，对所得数据进行统计学分析。结果：两组患者人口统计学资料、术前主弯Cobb角、主要侧凸类型比例和术中资料差异均无统计学意义（P>0.05）。术后A组平均引流量为26.67±26.61ml（0~90ml），平均输血量为红细胞悬液0.76±1.34U（0~5U），平均发热天数为2.14±1.39d（0~6d），72h体温峰值为37.95±0.53℃（37.3~39.3℃），平均置管时间为1.86±0.36d（1~2d）；术后B组平均引流量为1343.13±555.41ml（700~2350ml），平均输血量为红细胞悬液2.44±2.00U（0~5.5U），平均发热天数为1.75±1.24d（0~4d），72h体温峰值为37.82±0.44℃（37.3~38.7℃），平均置管时间为5.13±1.20d（3~7d）。两组术后切口引流量、置管时间及术后输血量差异均有统计学意义（P<0.05），但两组术后发热天数、72h体温峰值及切口愈合等级差异均无统计学意义（P>0.05），且均未出现切口感染。结论：特发性脊柱侧凸后路矫形术后放置皮下引流与肌层下引流相比，前者能够减少术后切口引流量、置管时间及术后输血量，同时未增加切口感染率，是一种较为安全的方法，具有一定的临床应用价值。

英文摘要:

  【Abstract】 Objectives: To observe and compare the results between subcutaneous closed suction drainage and submuscular closed suction drainage after posterior correction in idiopathic scoliosis. Methods: From February 2005 to September 2007, a total of 89 patients undergoing posterior scoliosis correction and allograft and instrument fusion in our hospital was studied retrospectively. The patients were classified into two groups: group A: subcutaneous closed suction drainage(n=42), and group B: submuscular closed suction drainage(n=47). To statistically analyze groups′perioperative data of the two groups, including demographics(age, gender, height, weight and BMI), preoperative main Cobb angle, intraoperative data(operating time, estimated blood loss, autologous blood transfusion, allogenic blood transfusion and levels fused), and postoperative drainage, blood transfusion, duration of fever, peak value of temperature in 72 hours, drainage duration, grades of healing incision and so on. Results: There was no significant difference with respect to the demographics, preoperative major curve Cobb angle, and intraoperative data between the two groups(P>0.05). The average drainage volume of group A was 26.67±26.61ml(0-90ml). The average blood transfusion was 0.76±1.34U(0-5U). The average duration of fever was 2.14±1.39d(0-6d). The peak value of temperature in 72 hours was 37.95±0.53℃(37.3-39.3℃). The average drainage duration was 1.86±0.36d(1-2d). While the average drainage volume of group B was 1343.13±555.41ml(700-2350ml). The average blood transfusion was 2.44±2.00U(0-5.5U). The average duration of fever was 1.75±1.24d(0-4d). The peak value of temperature in 72 hours was 37.82±0.44℃(37.3-38.7℃). The average drainage duration was 5.13±1.20d(3-7d). The differences in postoperative drainage volume, drainage duration and blood transfusion between group A and group B were statistically significant(P<0.05). However, there was no statistical significance with respect to the average duration of fever, peak value of temperature in 72 hours and grades of healing of incision between the two groups(P>0.05), and no wound infection was found. Conclusions: Compared with submuscular closed suction drainage, subcutaneous closed suction drainage after posterior correction in idiopathic scoliosis patients can reduce postoperative drainage volume, drainage duration and blood transfusion, while not increase the wound infection, which can be used in clinical practice.