背景:术后硬膜外血肿和伤口感染可导致脊柱手术中毁灭性的神经损伤。闭式引流是预防硬膜外血肿的常用方法,腰椎减压术后感染和相关的神经功能缺损;然而,目前尚不清楚引流是否能减少术后并发症,提高临床疗效。本研究旨在探讨闭式引流在减少单节段腰椎间盘摘除术术后并发症及提高临床疗效方面的作用。
方法:最终纳入420例单节段腰椎间盘突出症患者(女169例,男251例,年龄50.0±6.4岁)。共有214例患者被随机分配到封闭引流组,206例患者被分配到非引流组.术后发热的发生率,有症状的硬膜外血肿,通过卡方检验或Fisher精确检验比较两组患者的伤口感染和是否需要进行翻修手术.采用视觉模拟评分法(VAS)和Othwestry残疾指数(ODI)评价疼痛缓解改善情况和腰椎功能恢复情况。采用t检验比较两组的VAS和ODI评分。
结果:对两组并发症进行比较分析。术后发热率差异有统计学意义(p=0.022),由于非引流组的发热率较高,但是有症状的硬膜外血肿的发生率没有显着差异,伤口感染或翻修手术(p>0.05)。经过具体分析,发烧率低于38.5度,差异有统计学意义(p=0.027),但当发热大于38.5度时,差异无统计学意义(p>0.05)。比较术后第一天手术区域的VAS评分时,闭式引流组疼痛缓解情况明显优于非引流组,得分分别为5.1±0.8和6.0±0.7(p<0.001)。然而,两组手术区其他VAS评分无显著性差异,下肢VAS评分,或ODI评分(p>0.05)。
结论:对于单级腰椎间盘切除术,闭式引流有利于减少术后低热,减轻术后早期手术区疼痛。然而,引流术对降低术后并发症发生率或提高临床疗效无显著影响。
背景:电流控制试验ChiCTR1800016005,2018年5月6日,回顾性注册。
BACKGROUND: Postoperative epidural haematoma and wound infection can cause devastating neurological damage in spinal surgery. Closed drainage is a common method to prevent epidural haematoma, infection and related neurological impairment after lumbar decompression; however, it is not clear whether drainage can reduce postoperative complications and improve clinical efficacy. This randomized study aims to explore the role of closed drainage in reducing postoperative complications and improving the clinical efficacy of single-level lumbar discectomy.
METHODS: A total of 420 patients with single-level lumbar disc herniation were finally included in this study (169 females and 251 males, age 50.0 ± 6.4 years). A total of 214 patients were randomly assigned to the closed drainage group, and 206 patients were assigned to the non-drainage group. The incidence of postoperative fever, symptomatic epidural haematoma, wound infection and the need for revision surgery were compared between the two groups by the chi-square test or Fisher\'s exact test. The visual analogue scale (VAS) and oswestry disability index (ODI) were used to evaluate the improvement of pain relief and the recovery of lumbar function. The VAS and ODI scores were compared between the two groups using t tests.
RESULTS: The complications of the two groups were compared and analysed. There was only a statistically significant difference in the postoperative fever rate (p = 0.022), as the non-drainage group had a higher fever rate, but there were no significant differences in the rates of symptomatic epidural haematoma, wound infection or revision operation (p > 0.05). After concrete analysis, for the rate of fever less than 38.5 degrees, there was a statistically significant difference (p = 0.027), but there was no significant difference when the fever was greater than 38.5 degrees (p > 0.05). When comparing the VAS scores of the operation area on the first day after the operation, the pain relief in the closed drainage group was significantly better than that in the non-drainage group, with scores of 5.1 ± 0.8 and 6.0 ± 0.7, respectively (p < 0.001). However, there was no significant difference between the two groups in the other VAS scores of operation areas, the VAS scores of the lower extremity, or the ODI scores (p > 0.05).
CONCLUSIONS: For single-level lumbar discectomy, closed drainage is beneficial for reducing postoperative low-grade fever and relieving pain in the operation area in the very early postoperative stage. However, drainage does not have a significant impact on reducing the incidence of postoperative complications or improving clinical efficacy.
BACKGROUND: Current Controlled Trials ChiCTR1800016005 , May/06/2018, retrospectively registered.