| 摘要: |
| 目的 探讨腰椎手术后典型引流管相关疼痛（TDRP）的发生情况及预防措施。方法 回顾性分析2015年1月至2017年1月海军军医大学（第二军医大学）长海医院骨科收治的接受单节段后路腰椎椎体间融合术（PLIF）治疗的336例腰椎退行性病变患者的临床资料，比较引流管出肌点与L3、L4、L5、S1椎体平齐患者PLIF术后TDRP的发生情况及缓解方式。前瞻性选择2017年6月至2018年6月海军军医大学（第二军医大学）长海医院骨科收治的因腰椎退行性病变拟行单节段经椎间孔腰椎椎体间融合术（TLIF）的100例患者，随机选取患者一侧为L4组，另一侧为L5组：L4组引流管出肌点与L4椎体上缘平齐，L5组引流管出肌点与L5椎体下缘平齐，比较两组术后TDRP的发生情况及缓解方式、引流量、引流管留置时间、切口敷料渗出和伤口并发症发生率等。结果 PLIF术后发生TDRP（n=65）和不发生TDRP（n=271）的患者性别、年龄、BMI、手术时间、术中失血量、术后引流量、引流管留置时间、术后发热持续时间差异均无统计学意义（P均>0.05），术前1 d、术后3 d、出院时血红蛋白和血细胞比容差异亦均无统计学意义（P均>0.05）。336例患者中，PLIF术后引流管出肌点与L3、L4、L5、S1椎体平齐者分别为63、94、110、69例，术后TDRP发生率分别为0、5.32%（5例）、29.09%（32例）、40.58%（28例）；65例术后发生TDRP的患者中，4例（6.15%）在拔除引流管后疼痛即缓解，5例（7.69%）在拔除引流管后通过改变体位疼痛突然缓解，39例（60.00%）在拔除引流管后经热敷理疗疼痛明显缓解（一般在2个月内缓解），12例（18.46%）在拔除引流管后通过非甾体抗炎药治疗疼痛缓解，5例（7.69%）在拔除引流管后通过封闭治疗疼痛缓解。前瞻性研究中，L4组和L5组术后引流量、引流管留置时间、术后第2天伤口渗出情况及伤口并发症发生率的差异均无统计学意义（P均>0.05）。L5组39例（39.00%）患者TLIF术后发生TDRP，发生率高于L4组（4例，4.00%），差异有统计学意义（χ2=36.291，P<0.01）；L5组和L4组分别有71.79%（28/39）和75.00%（3/4）患者的疼痛症状可以通过热敷理疗缓解，差异无统计学意义（χ2=0.018，P=0.893）。结论 腰椎手术后引流管出肌点在平L5椎体水平及以下的腰椎退行性病变患者术后TDRP的发生率较高，故建议腰椎术后引流管从L5椎体以上平面穿出。 |
| 关键词: 引流术 疼痛 出肌点 后路腰椎椎体间融合术 经椎间孔腰椎椎体间融合术 |
| DOI：10.16781/j.0258-879x.2020.03.0281 |
| 投稿时间：2019-05-31修订日期：2019-06-26 |
| 基金项目:国家自然科学基金（81701199），重大疑难疾病中西医临床协作试点项目[ZY （2018-2020）-FWTX-2005]. |
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| Retrospective and prospective observation of typical drainage-related pain after lumbar surgery |
| DUAN Xiao-peng1△,CHEN Kai1△,FU Qing-cheng2,LIU Zhao-chen3,ZHAI Xiao1,MAO Ning-fang1*,LI Ming1 |
(1. Department of Orthopaedics, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China;
2. Department of Hematology, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China;
3. Scientific Research Office, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To explore the incidence and precautionary methods of typical drainage-related pain (TDRP) after lumbar surgery. Methods The clinical data of 336 patients with degenerative lumbar disease, who underwent singlelevel posterior lumbar interbody fusion (PLIF) surgery from Jan. 2015 to Jan. 2017 in Orthopaedics Department of Changhai Hospital of Naval Medical University (Second Military Medical University), were retrospectively analyzed. The incidence and relief methods of TDRP were compared between the patients with exit point of muscle of drainage tube at L3, L4, L5 and S 1 levels. A total of 100 patients with degenerative lumbar disease, who underwent single-level transforaminal lumbar interbody fusion (TLIF) surgery from Jun. 2017 to Jun. 2018 in Orthopaedics Department of Changhai Hospital of Naval Medical University (Second Military Medical University), were prospectively enrolled. One side of the patients was randomly selected as L 4 group and the other side as L5 group. The exit points of muscle of drainage tubes in L4 group were in line with the superior endplate of the L4, and those in L5 group were in line with the inferior endplate of the L5. The incidence and relief methods of TDRP, drainage volume, drainage duration, dressing saturation grades and wound complications were compared between the two groups after surgery. Results There were no significant differences in gender, age, body mass index (BMI), operation time, intraoperative blood loss, postoperative drainage volume, drainage duration, duration of fever, or hemoglobin or hematocrit one day before surgery, three days after surgery and at discharge between the patients with TDRP (n=65) and without TDRP (n=271) after PLIF (all P>0.05). There were 63, 94, 110 and 69 patients with exit points of muscle of drainage tube at L3, L4, L5 and S1 levels, respectively; and the incidence rates of TDRP were 0, 5.32% (5 cases), 29.09% (32 cases) and 40.58% (28 cases), respectively. Among the 65 patients with TDRP, four patients (6.15%) were relieved after removal of drainage tube, five patients (7.69%) had sudden relief by changing body position after drainage tube removal, 39 patients (60.00%) were relieved obviously by thermotherapy (generally within two months) after drainage tube removal, 12 patients (18.46%) were relieved by non-steroidal anti-inflammatory drugs after removal of drainage tube, and five patients (7.69%) were relieved by local blockage after the drainage tube removal. In the prospective study, there were no significant differences in postoperative drainage volume, drainage duration, wound dressing two days after surgery or the incidence of wound complications between the L4 group and L5 group (all P>0.05). The incidence rate of TDRP was significantly higher in the L 5 group than that in the L4 group (39.00%[39/100]vs 4.00%[4/100], χ2=36.291, P<0.01). Pain symptoms of 71.79% (28/39) and 75.00% (3/4) patients could be relieved by thermotherapy after removal of drainage tube in the L5 group and the L 4 group, respectively. Conclusion The incidence of TDRP is high in patients with lumbar degenerative disease whose exit points of muscle of drainage tubes are at or below the level of the L5 vertebral body after surgery. It is suggested that the exit points of muscle of drainage tubes should be above the level of L5 vertebral body after lumbar surgery. |
| Key words: drainage pain exit point of muscle posterior lumbar interbody fusion transforaminal lumbar interbody fusion |
