腰椎后路椎体间融合方式对术中出血量及术后引流量的影响
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摘要
[目的]探讨腰椎后路椎体间融合的不同方式对术中出血量及术后引流量的影响。[方法]自数据库中选取2010年6月～2012年1月在本科因腰椎疾病初次手术的患者共79例纳入本研究,男35例,女44例,年龄32～79岁,平均(56.94±1.15)岁。按椎体间融合方式分为,自体骨植入组37例,自体骨加融合器置入42例。所有患者均记录手术时间、手术节段、术中应用自体血量、术中应用同种异体血量、术中出血量、术后即刻的引流量、引流管体内放置时间、最终引流量及血小板计数。[结果]自体骨植入组手术时间少于自体骨加融合器组,术中出血量少于自体骨加融合器组,但差异无统计学意义(P>0.05)。自体骨植入组术中自体血输入量显著少于自体骨加融合器组,差异有统计学意义(P<0.05)。两组患者手术时间均与术中失血量呈正相关(P<0.05),自体骨组引流管放置时间与最终引流量呈正相关(P<0.05)。[结论]腰椎后路手术椎体间融合的不同方式对术中出血量及术后引流量没有显著性影响,但是,手术时间与术中出血量呈正相关。
[Objective] To investigate the effect of different methods in posterior lumbar interbody fusion on intraoperative blood loss and postoperative drainage. [Methods]From June 2010 to January 2012, 79 patients who underwent primary surgery for lumbar disease in our department were enrolled in this study by selecting from our database. The patients included 35 males and 44 females and aged 32-79 years with an average of(56.94±1.15) years. In term of interbody fusion method applied,37 patients had the intervertebral space fused with bone autograft only(the BA group), while the remaining 42 patients received the fusion with bone autograft combined with cage(the BAC group). The operation time, intraoperative blood loss, drainage volume immediately after operation, the time of drainage tube stay and the final drainage volume were recorded and compared between the two groups. [Results]The BA group consumed slightly shorter operation time and had slightly less intraoperative blood loss than the BAC group, although there were no statistically significant differences between the two group(P>0.05). The BA group received significantly less volume of autotransfusion than the BAC group(P<0.05). There were significantly positive correlations between the operation time and intraoperative blood loss in both group(P<0.05). In addition, the time of drainage tube stay was significantly positively correlated with the final drainage volume in the BA group(P<0.05). [Conclusions]There is no significant effect of the two fusion methods on intraoperative bleeding volume and postoperative drainage volume in lumbar posterior interbody fusion, but the operation time is positively correlated to the intraoperative blood loss.
[Objective] To investigate the effect of different methods in posterior lumbar interbody fusion on intraoperative blood loss and postoperative drainage. [Methods]From June 2010 to January 2012, 79 patients who underwent primary surgery for lumbar disease in our department were enrolled in this study by selecting from our database. The patients included 35 males and 44 females and aged 32-79 years with an average of(56.94±1.15) years. In term of interbody fusion method applied,37 patients had the intervertebral space fused with bone autograft only(the BA group), while the remaining 42 patients received the fusion with bone autograft combined with cage(the BAC group). The operation time, intraoperative blood loss, drainage volume immediately after operation, the time of drainage tube stay and the final drainage volume were recorded and compared between the two groups. [Results]The BA group consumed slightly shorter operation time and had slightly less intraoperative blood loss than the BAC group, although there were no statistically significant differences between the two group(P>0.05). The BA group received significantly less volume of autotransfusion than the BAC group(P<0.05). There were significantly positive correlations between the operation time and intraoperative blood loss in both group(P<0.05). In addition, the time of drainage tube stay was significantly positively correlated with the final drainage volume in the BA group(P<0.05). [Conclusions]There is no significant effect of the two fusion methods on intraoperative bleeding volume and postoperative drainage volume in lumbar posterior interbody fusion, but the operation time is positively correlated to the intraoperative blood loss.
引文
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[5] Mummaneni PV, Haid RW, Rodts GE. Lumbar interbody fusion:state-of-the-art technical advances. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004[J]. J Neurosurg Spine, 2004, 1(1):24-30.
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[8] Walid MS. The role of drains in lumbar spine fusion[J].World Neurosurg, 2012, 77(3-4):564-568.
[2] Buckwalter JA. Aging and degeneration of the human intervertebral disc[J].Spine(Phila Pa 1976), 1995, 20(11):1307-1314.
[3] Modic MT. Degenerative disk disease:assessment of changes in vertebral body marrow with MR imaging[J]. Radiology, 1988, 166(1):193-199.
[4] De Kunder SL. Transforaminal lumbar interbody fusion(TLIF)versus posterior lumbar interbody fusion(PLIF)in lumbar spondylolisthesis:a systematic review and meta-analysis[J]. Spine J, 2017,17(11):1712-1721.
[5] Mummaneni PV, Haid RW, Rodts GE. Lumbar interbody fusion:state-of-the-art technical advances. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004[J]. J Neurosurg Spine, 2004, 1(1):24-30.
[6]. Blank J. The use of postoperative subcutaneous closed suction drainage after posterior spinal fusion in adolescents with idiopathic scoliosis[J]. J Spinal Disord Tech, 2003, 16(6):508-512.
[7] Ho C, Sucato DJ, Richards BS. Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis patients[J]. Spine(Phila Pa 1976), 2007, 32(20):2272-2277.
[8] Walid MS. The role of drains in lumbar spine fusion[J].World Neurosurg, 2012, 77(3-4):564-568.