摘要
背景:加速康复外科(ERAS)在骨科领域受到广泛关注与推崇,但尚无ERAS在经皮脊柱内镜辅助下腰椎椎体间融合术(PT-Endo-LIF)治疗腰椎退行性疾病(LDD)中的应用效果的相关报道。目的:探讨ERAS在PT-Endo-LIF治疗LDD中的应用效果。方法:前瞻性纳入2017年10月至2019年2月采用PT-Endo-LIF手术治疗单节段LDD患者90例,按照随机数字表分为对照组45例,围手术期采取常规干预模式;ERAS组45例,围手术期采取ERAS干预模式。记录患者的一般资料、手术时间、术中出血量、术后卧床时间、住院时间、围手术期并发症等指标。采用VAS评分、JOA评分和ODI指数评估患者术前、术后的疼痛程度及功能状态。采用改良MacNab标准和Likert量表分别评估患者手术疗效及满意度。采用改良Bridwell分级标准评估患者影像学融合率。结果:所有患者均获得至少12个月的随访。两组在性别、年龄、体重指数、术前诊断及手术节段的差异无统计学意义(P>0.05)。两组在手术时间及术中出血量的差异无统计学意义(P>0.05)。两组在术后卧床时间和住院时间的差异有统计学意义(P<0.05)。ERAS组术后3 d及术后1个月的VAS、JOA、ODI均优于对照组,差异有统计学意义(P<0.05)。所有患者术中均无手术节段定位错误、血管神经损伤、硬膜囊撕裂、神经根撕裂,术后无椎间隙感染、脑脊液漏等严重并发症。ERAS组患者术后3 d、术后1个月和末次随访时的满意度均优于对照组(P<0.05)。按照改良MacNab标准,ERAS组优良率与对照组的差异无统计学意义(P>0.05)。末次随访时,按照改良Bridwell分级,所有患者均已融合(100%),两组影像学融合率的差异无统计学意义(P>0.05)。结论:PT-Endo-LIF手术治疗LDD的围手术期采用ERAS干预模式可缩短患者的术后卧床时间、住院时间,明显改善患者术后疼痛及腰椎功能。
Background:The concept of enhanced recovery after surgery(ERAS)has been widely concerned and respected in the field of orthopedic surgery.However,there is no report on the effect of ERAS in percutaneous transforaminal endoscope-assisted lumbar interbody fusion(PT-Endo-LIF)in the treatment of lumbar degenerative diseases(LDD).Objective:To explore the effect of ERAS in the treatment of LDD with PT-Endo-LIF.Methods:From October 2017 to February 2019,90 patients with LDD undergoing PT-Endo-LIF combined with posterior percutaneous pedicle screws fixation were enrolled and divided into two groups according to randomized number table:the control group(n=45)receiving routine intervention during perioperative period and the ERAS group(n=45)receiving ERAS model.General information of patients,operation time,intraoperative blood loss,off-bed time,hospital stay and perioperative complications were recorded.VAS,JOA and ODI were used to evaluate the pain and lumbar functions.The Likert scale was used to evaluate the patients'satisfaction.Clinical outcomes were evaluated using MacNab criteria at the last follow-up.The imaging fusion rate was evaluated by modified Bridwell classification.Results:All patients were followed up for at least 12 months.There was no significant difference in gender,age,BMI,preoperative diagnosis,operation segment,intraoperative bleeding and operation time between the two groups(P>0.05).Offbed time and hospital stay were shorter in ERAS group than in the control group(P<0.05).VAS,JOA and ODI were better in ERAS group than in the control group at three days and one month after the operation(P<0.05).No serious complications such as segment error,vascular and nerve injury,dural sac tear,nerve root tear,postoperative intervertebral space infection and cerebrospinal fluid leakage were found in the patients.Patient's satisfaction were better in ERAS group than in the control group at three days and one omnth after the operation and the final follow-up(P<0.05).At the last follow-up,the,and all patients achieved solid fusion(100%)according to the modified Bridwell grade.There was no significant difference in imaging fusion rate between the two groups(P>0.05).Conclusions:ERAS nursing mode can decrease off-bed time,hospital stay and perioperative complications,relieve postoperative pain,and improve lumbar function in the treatment of LDD with PT-Endo-LIF.
作者
赵廷潇
张骏
周乾坤
邵海宇
金梦然
刘建文
陈锦平
黄亚增
ZHAO Tingxiao;ZHANG Jun;ZHOU Qiankun;SHAO Haiyu;JIN Mengran;LIU Jianwen;CHEN Jinping;HUANG Yazeng(Graduate School of Bengbu Medical College,Bengbu,Anhui 233000;Department of Orthopedics,Zhejiang Provincial People's Hospital,Hangzhou 310014,China)
出处
《中华骨与关节外科杂志》
2020年第9期712-718,共7页
Chinese Journal of Bone and Joint Surgery
基金
浙江省医药卫生科技计划项目(2018KY017,2020KY408)。
关键词
脊柱融合术
脊柱内镜
加速康复外科
腰椎退行性疾病
Spinal Fusion
Spinal Endoscope
Enhanced Recovery After Surgery
Lumbar Degenerative Disease
