CAJ | 학술논문

目的通过与传统的骶棘肌游离法进行比较,探讨骶棘肌复位缝合法在腰椎后路手术中的应用效果.方法 2005年7月至2010年7月对303例患者行保留棘突腰椎后路手术,男181例,女128例;年龄18～82岁,平均38.6岁;按疾病类型、手术方式及骨折节段分别采用:腰椎间盘突出症单纯椎板间隙开窗髓核摘除、腰椎间盘突出症半椎板切除髓核完全摘除椎间植骨融合内固定、单一节段骨折固定及2个节段骨折固定4种方法治疗.对所有患者的切口关闭随机采用2种方法:骶棘肌复位缝合法(骶棘肌复位组158例)和骶棘肌游离法(骶棘肌游离组145例).记录患者术后24、48h内引流血量、切口愈合不良发生数及拆线时间,根据手术前、后血红蛋白检测结果计算患者血红蛋白的丢失率,并对两组数据进行比较.结果骶棘肌复位组24、48 h切口引流血量低于骶棘肌游离组,差异均有统计学意义(P＜0.05);腰椎间盘突出症行单纯髓核摘除术、单一节段骨折、2个节段骨折的骶棘肌复位组的48 h血红蛋白丢失率低于骶棘肌游离组,差异均有统计学意义(P＜0.05);骶棘肌复位组的切口愈合不良发生率低于骶棘肌游离组,差异有统计学意义(P＜0.05).拆线时间两组差异均无统计学意义(P＞0.05).结论在保留棘突的腰椎后路手术切口缝合中,与骶棘肌游离法比较,采用骶棘肌复位缝合法能明显减少术后引流量、切口愈合不良等发生率,是一种良好的缝合方法.
목적 통과여전통적저극기유리법진행비교,탐토저극기복위봉합법재요추후로수술중적응용효과.방법 2005년7월지2010년7월대303례환자행보류극돌요추후로수술,남181례,녀128례;년령18～82세,평균38.6세;안질병류형、수술방식급골절절단분별채용:요추간반돌출증단순추판간극개창수핵적제、요추간반돌출증반추판절제수핵완전적제추간식골융합내고정、단일절단골절고정급2개절단골절고정4충방법치료.대소유환자적절구관폐수궤채용2충방법:저극기복위봉합법(저극기복위조158례)화저극기유리법(저극기유리조145례).기록환자술후24、48h내인류혈량、절구유합불량발생수급탁선시간,근거수술전、후혈홍단백검측결과계산환자혈홍단백적주실솔,병대량조수거진행비교.결과 저극기복위조24、48 h절구인류혈량저우저극기유리조,차이균유통계학의의(P＜0.05);요추간반돌출증행단순수핵적제술、단일절단골절、2개절단골절적저극기복위조적48 h혈홍단백주실솔저우저극기유리조,차이균유통계학의의(P＜0.05);저극기복위조적절구유합불량발생솔저우저극기유리조,차이유통계학의의(P＜0.05).탁선시간량조차이균무통계학의의(P＞0.05).결론 재보류극돌적요추후로수술절구봉합중,여저극기유리법비교,채용저극기복위봉합법능명현감소술후인류량、절구유합불량등발생솔,시일충량호적봉합방법.
Objective To compare the clinical outcomes of suture with sacrospinal muscle reposition and conventional suture with sacrospinal muscle floating in posterior lumbar surgery without removal of the spinous process. Methods Between July 2005 and July 2010,303 patients underwent posterior lumbar operations without removal of the spinous process.They were 181 men and 122 women,aged from 18 to 82years (mean,38.6 years) .The 2 methods of suture were randomly adopted for the patients in the surgery.Suture with sacrospinal muscle reposition was used in 158 cases and conventional suture with sacrospinal muscle floating in 145 cases.The drainage volumes at 24 and 48 hours after operation,malunion rates,and time for removal of stitches were recorded and loss of hemoglobin was calculated according to the hemoglobin counts before and after operation.All the data were statistically analyzed using SPSS11.0 software to compare the effects of the 2 suture methods. Results There were significant differences between the 2 sutures in drainage volumes at 24 and 48 hours after operation,hemoglobin loss at 48 hours after operation in most cases,and malunion rate (P＜0.05),indicating the reposition suture was superior to the floating suture.There was no significant difference in time for removal of stitches between the 2 methods(P＞0.05) . Conclusion In posterior lumbar surgery not to remove the spinous process,suture with sacrospinal muscle reposition may be superior to the conventional suture with sacrospinal muscle floating.