von Eckardstein Kajetan L, Dohmes Jaqueline E, Rohde Veit
Department of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37070, Göttingen, Germany.
Eur Spine J. 2016 Mar;25(3):708-15. doi: 10.1007/s00586-015-3790-8. Epub 2015 Feb 8.
The risks of drains in spine surgery (e.g., increasing venous plexus bleeding, maintaining CSF leakage, and infections) must be balanced with their benefits (e.g., reduced rate of postoperative hematoma and seroma formation). Little is known about factors that influence surgeons' decision to employ a drain.
We conducted a survey among German spine surgeons regarding their use of drains. Neurosurgical and orthopedic departments along with privately practicing neurosurgeons were invited to complete an online questionnaire featuring general and case-specific questions with regard to drain placement.
We received 163 questionnaires (private practice and small-volume centers 36.1%, medium- and large-volume centers 43.6%, university centers 20.2%). Factors influencing the decision to use a drain include size of wound, type of procedure, hemostasis at the end of the procedure, and coagulopathies; factors found to be less important include overall blood loss, body mass index, and implants. 31% of surgeons will use drains for microdiskectomies. For other pathologies, percentages are as follows: anterior cervical diskectomy and fusion, 58%; cervical laminoplasty, 62%; hemilaminectomy for bisegmental lumbar stenosis, 69%; transpedicular instrumentation, 88%; vertebral body replacement for metastasis, 94%. Over half of those who usually employ a drain will not use a drain in cases of unintentional durotomy.
In terms of indication, duration, and safety measures, use of drains in spinal surgery is heterogeneous. The majority of surgeons prefer drains to suction in most cases, except for microdiskectomies, for which only 31% will use a drain. Nearly all colleagues discontinue drains by day 4.
脊柱手术中引流管的风险（如增加静脉丛出血、持续脑脊液漏和感染）必须与其益处（如降低术后血肿和血清肿形成率）相权衡。关于影响外科医生决定使用引流管的因素，人们知之甚少。
我们对德国脊柱外科医生使用引流管的情况进行了一项调查。邀请神经外科和骨科科室以及私人执业神经外科医生填写一份在线问卷，问卷包含有关引流管放置的一般问题和特定病例问题。
我们收到了163份问卷（私人执业和小容量中心占36.1%，中大容量中心占43.6%，大学中心占20.2%）。影响使用引流管决定的因素包括伤口大小、手术类型、手术结束时的止血情况和凝血障碍；被认为不太重要的因素包括总失血量、体重指数和植入物。31%的外科医生会在显微椎间盘切除术中使用引流管。对于其他病理情况，使用比例如下：前路颈椎间盘切除融合术，58%；颈椎椎板成形术，62%；双节段腰椎管狭窄半椎板切除术，69%；经椎弓根内固定术，88%；椎体转移瘤置换术，94%。超过一半通常使用引流管的医生在意外硬脊膜切开的情况下不会使用引流管。
在适应证、持续时间和安全措施方面，脊柱手术中引流管的使用情况各不相同。在大多数情况下，除了显微椎间盘切除术（只有31%的医生会使用引流管）外，大多数外科医生更喜欢使用引流管而不是吸引器。几乎所有同事在第4天停止使用引流管。
