颈后路单开门椎管扩大成形术后常压引流与负压引流的临床效果比较

Drainage after expansive open-door laminoplasty: natural pressure vs negative pressure

中文关键词:  椎管扩大成形术  常压引流  负压引流  切口感染  症状性血肿

英文关键词:Natural pressure drainage  Negative pressure drainage  Expansive open-door laminoplasty  Surgical site infection  Symptomatic epidural hematoma

中文摘要:

  【摘要】　目的：评估和比较颈椎后路单开门椎管扩大成形术后常压引流和负压引流的临床有效性。方法：回顾性分析2015年9月~2017年3月在我院行颈椎后路单开门椎管扩大成形术的146例患者，根据术后引流管留置压力的不同分为常压引流组（n=78）和负压引流组（n=６8）。比较两组患者术后第1天引流量、术后总引流量、引流管留置时间、术后发热的发生率、切口感染发生率、症状性血肿发生率、手术前后日本骨科协会（Japanese Orthopedic Association，JOA）脊髓功能评分（17分法）和JOA评分改善率。结果：颈椎后路单开门椎管扩大成形术后，常压引流组术后第一天引流量中位数为50.0ml（30.0，80.0ml），负压引流组为212.5ml（160.0，262.5ml），两组间差异有统计学意义（P<0.05）；常压引流组术后总引流量中位数为141.0ml（105.0，200.0ml），负压引流组为367.5ml（297.5，470.0ml），两组间差异有统计学意义（P<0.05）；常压引流组术后引流管留置时间中位数为3.0d（2.0，3.0d），负压引流组为3.0d（3.0，4.0d），两组间差异有统计学意义（P<0.05）；两组术后发热、切口感染及症状性血肿的发生率无显著性差异（P>0.05）；两组在术后3个月及术后12个月随访时的ＪＯＡ评分改善率无显著性差异（P>0.05）。结论：颈椎后路单开门椎管扩大成形术后应用常压引流与应用负压引流临床疗效一致，但常压引流可以降低术后引流量，减少引流管留置时间。

英文摘要:

  【Abstrct】 Objectives: To compare the clinical outcomes between natural pressure drainage and negative pressure drainage after expansive open-door laminoplasty. Methods: From September 2015 to March 2017, 146 patients in the spine group of Orthopedic Department of Peking University Third Hospital who underwent cervical expansive open-door laminoplasty were reviewed and divided into natural pressure group and negative pressure group according to different pressure of postoperative drainage. The following parameters were compared: drainage volume at the 1st postoperative day, the total volume of postoperative drainage, the total drainage days, postoperative fever, rate of surgical site infection, symptomatic epidural hematoma, preoperative and postoperative JOA score, the JOA improvement rate. Results: The median drainage volume at the 1st postoperative day in the natural pressure group was 50.0ml(30.0, 80.0ml), while in the negative pressure group it was 212.5ml(160.0, 262.5ml)(P<0.05). The median total volume of postoperative drainage in the natural pressure group was 141.0ml(105.0, 200.0ml), while in the negative pressure group it was 367.5ml(297.5, 470.0ml)(P<0.05). The number of median total drainage days in the natural pressure group was 3.0(2.0, 3.0), while in the negative pressure group it was 3.0(3.0, 4.0)(P<0.05). There was no significant difference between the two groups in the morbidity of postoperative fever, rate of surgical site infection or the morbidity of symptomatic epidural hematoma(P>0.05). And there was no significant difference between the two groups in the neurological functional prognosis at the 3 months and the 12 months follow-up(P>0.05). Conclusions: Natural pressure drainage is as safe and effective as negative pressure drainage after expansive open-door laminoplasty. But natural pressure drainage can decrease both the total volume of postoperative drainage and total drainage days.