切口内留置引流管对腰椎后路椎管减压内固定术后患者切口愈合和感染指标的影响

张楠; 王苗; 张鹏; 马超; 郜顺兴; 刘红正; 陶晓冰

doi:10.16766/j.cnki.issn.1674-4152.003490

切口内留置引流管对腰椎后路椎管减压内固定术后患者切口愈合和感染指标的影响

doi: 10.16766/j.cnki.issn.1674-4152.003490

张楠^1, ,,
王苗²,
张鹏¹,
马超¹,
郜顺兴¹,
刘红正¹,
陶晓冰¹

1.
河北省沧州中西医结合医院脊柱脊髓外四科，河北省中西医结合骨关节病研究重点实验室(筹)，河北沧州 061000
2.
河北省沧州中西医结合医院放化疗科

基金项目:

河北省医学科学研究课题计划 20200605

详细信息

通讯作者:
张楠，E-mail: zhangnanwm@126.com

中图分类号: R681.53 R687.43
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出版历程
- 收稿日期: 2023-11-22
- 网络出版日期: 2024-07-20

Effect of indwelling drainage tube on wound healing and infection indexes in patients after posterior lumbar decompression and internal fixation surgery

1.
Department of Spinal Surgery 4, Hebei Cangzhou Integrated Traditional Chinese and Western Medicine Hospital Spinal, Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing), Cangzhou, Hebei 061000, China

摘要

摘要: 目的腰椎后路椎管内固定术切口引流管对于患者术后恢复有着重要的影响, 本研究采用切口内留置引流管方案, 旨在进一步改善腰椎后路椎管减压内固定患者预后。方法选择2019年6月-2022年5月于河北省沧州中西医结合医院放化疗科行腰椎后路椎管减压内固定术的98例患者, 其中50例患者术后超过48 h且小于1周拔出引流管(A组), 另外48例患者术后48 h内拔出引流管(B组)。比较2组患者一般资料、术中指标、术后切口愈合情况、感染指标及并发症发生情况。结果 2组患者的一般资料比较差异均无统计学意义(P>0.05)。A组术后引流量多于B组[(183.04±47.36) mL vs.(164.01±29.68) mL, P < 0.05], 术后5 d内的换药频次小于B组[(2.01±0.62)次/d vs.(2.69±0.72)次/d, P < 0.05], 2组患者术后下地活动时间和总住院时间比较差异均无统计学意义(P>0.05)。2组患者末次随访时手术切口愈合情况比较差异无统计学意义(P>0.05), A组引流管相关并发症总发生率低于B组(12.00%vs.29.17%, P < 0.05)。术后第3天, A组体温、白细胞(WBC)计数、中性粒细胞(NEU)浓度和血清C-反应蛋白(CRP)浓度均低于B组(P < 0.05)。结论切口内留置引流管在腰椎后路椎管减压内固定术后留置超过48 h且小于1周, 有利于降低感染指标和并发症的发生率, 对患者切口愈合并无显著影响。
- 腰椎后路椎管减压内固定术 /
- 切口内留置引流管 /
- 切口愈合 /
- 感染指标 /
- 并发症
Abstract: Objective The incision drainage tube of posterior lumbar spinal canal fixation has an important impact on the postoperative recovery of patients.In this study, the incision indwelling drainage tube scheme was adopted, aiming to further improve the prognosis of patients with posterior lumbar decompression and internal fixation. Methods A total of 98 patients who underwent posterior lumbar decompression and internal fixation surgery in the Department of Radiotherapy and Chemotherapy in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province from June 2019 to May 2022 were selected, among which 50 patients had their drainage tube removed more than 48 hours and less than one week after surgery (group A), and the other 48 patients had their drainage tube removed within 48 hours after surgery (group B).The general data, intraoperative indexes, postoperative incision healing, infection indexes and complications were compared between the two groups. Results There were no statistically significant differences in general data between the two groups (P>0.05).The postoperative drainage volume in group A was higher than that in group B[(183.04±47.36) mL vs.(164.01±29.68) mL, P < 0.05], and the frequency of dressing change within 5 days after surgery was lower than that in group B[(2.01±0.62) times/d vs.(2.69±0.72) times/d, P < 0.05].There was no difference in postoperative ground activity time and total hospital stay between the two groups (P>0.05).There was no difference in incision healing between the two groups at the last follow-up (P>0.05), and the total incidence of drainage tube related complications in group A was lower than that in group B (12.00%vs.29.17%, P < 0.05).The body temperature, white blood cell count (WBC), neutrophil (NEU) concentration and C-reactive protein (CRP) in group A were all lower than those in group B on the third day after surgery (P < 0.05). Conclusion The indwelling of drainage tube in the incision after posterior lumbar decompression and internal fixation surgery for more than 48 hours and less than one week is conducive to reducing the infection indicators and the incidence of complications, and has no significant effect on the wound healing of patients.
- Posterior lumbar decompression and internal fixation /
- Indwelling drainage tube in incision /
- Wound healing /
- Indicators of infection /
- Complications

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表 1 2组腰椎患者一般资料比较

Table 1. Comparison of general data for two groups of lumbar spine patients

组别	例数	性别(例)		年龄 (x±s，岁)	病程 (x±s，年)	手术节段(例)				疾病类型(例)		手术时间 (x±s，min)	切口长度 (x±s，mm)	术中出血 (x±s，mL)
组别	例数	男性	女性	年龄 (x±s，岁)	病程 (x±s，年)	L_2~3	L_3~4	L_4~5	L₅~S₁	腰椎间盘突出	腰椎管狭窄	手术时间 (x±s，min)	切口长度 (x±s，mm)	术中出血 (x±s，mL)
A组	50	30	20	61.22±8.54	2.91±0.55	0	10	31	9	25	25	60.39±10.82	18.04±2.42	67.54±10.26
B组	48	27	21	60.36±4.98	2.68±0.62	1	7	35	5	33	15	64.01±17.23	17.52±3.07	62.77±15.02
统计量		0.142^a		0.606^b	1.945^b	2.875^c				3.564^a		1.251^b	0.933^b	1.842^b
P值		0.707		0.546	0.055	0.411				0.059		0.214	0.353	0.069
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 2组腰椎患者术后引流情况和恢复进度比较(x ±s)

Table 2. Comparison of postoperative drainage and recovery progress in two groups of lumbar spine patients (x ±s)

组别	例数	术后引流量 (mL)	术后5 d内的换药频次(次/d)	术后下地活动时间(d)	总住院时间(d)
A组	50	183.04±47.36	2.01±0.62	2.09±0.55	6.90±2.13
B组	48	164.01±29.68	2.69±0.72	1.87±0.61	7.23±1.18
t值		2.372	5.016	1.877	0.943
P值		0.020	＜0.001	0.064	0.348

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表 3 2组腰椎患者手术切口愈合等级比较[例(%)]

Table 3. Comparison of surgical incision healing grades in two groups of lumbar spine patients [cases (%)]

组别		甲级	乙级	丙级
A组	50	8(16.00)	38(76.00)	4(8.00)
B组	48	6(12.50)	31(64.58)	11(22.92)
Z值		2.801
P值		0.094

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表 4 2组腰椎患者与引流管相关并发症发生情况比较[例(%)]

Table 4. Comparison of drainage-related complications between two groups of lumbar spine patients [cases (%)]

组别	例数	引流管堵塞	切口感染	切口愈合延迟	伤口撕裂	部分引流	总发生
A组	50	1(2.00)	1(2.00)	2(4.00)	2(4.00)	0	6(12.00)
B组	48	1(2.08)	6(12.50)	5(10.42)	1(2.08)	1(2.08)	14(29.17)
χ²值		0.470	2.642	0.707	0.001		4.443
P值		0.493	0.104	0.401	0.971	0490^a	0.035
注：^a为采用Fisher精确检验。

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表 5 2组腰椎患者感染相关指标比较(x ±s)

Table 5. Comparison of infection-related indicators in two groups of lumbar spine patients (x ±s)

组别	例数	体温(℃)		t值	P值	WBC(×10⁹/L)		t值	P值	NEU(×10⁹/L)		t值	P值	CRP(mg/L)		t值	P值
组别	例数	术前	术后第3天	t值	P值	术前	术后第3天	t值	P值	术前	术后第3天	t值	P值	术前	术后第3天	t值	P值
A组	50	36.50±0.24	37.65±0.54	13.427	< 0.001	6.65±1.80	10.32±2.49	5.354	< 0.001	6.48±0.57	8.00±1.25	9.036	< 0.001	1.90±0.40	40.65±7.69	2.439	< 0.001
B组	48	36.39±0.32	37.90±0.42	13.043	< 0.001	6.70±0.95	11.36±2.57	5.720	< 0.001	6.62±0.29	8.92±0.68	9.137	< 0.001	1.76±0.37	60.35±10.57	6.172	< 0.001
统计量		1.930^a	153.041^b			0.171^a	120.015^b	1.523^a	220.549^b			1.797^a	195.044^b
P值		0.057	< 0.001			0.865	< 0.001	0.131	< 0.001			0.076	< 0.001
注：^a为t值，^b为F值。

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