Andrew Glennie R, Dea Nicolas, Street John T
Dalhousie University, 1798 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada; Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, BC, Canada.
Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, BC, Canada.
J Clin Neurosci. 2015 Jul;22(7):1081-7. doi: 10.1016/j.jocn.2015.01.009. Epub 2015 Mar 25.
The purpose of this study was to systematically search, critically appraise and summarize published randomized control trials (RCT) and non-RCT examining the effect of drains and dressings on wound healing rates and complications in posterior spine surgery. The use of post-operative drains and the type of post-operative dressing is at the discretion of the treating surgeon with no available clinical guidelines. Drains will theoretically decrease incidence of post-operative hematoma and therefore, potentially decrease the risk of neurologic compromise when the neural elements have been exposed. Occlusive dressings have more recently been advocated, potentially maintaining a sterile barrier for longer time periods post-operatively. A systematic review of databases from 1969-2013 was undertaken. All papers examining drains in spine surgery and dressings in primary healing of surgical wounds were included. Revman (version 5.2; The Nordic Cochrane Centre, The Cochrane Collaboration, Oxford, UK) was used to test for overall treatment effect, clinical heterogeneity and risk of bias. Of the papers identified, 1348 examined post-operative drains in spine surgery and 979 wound dressings for primary wound healing of all surgical wounds. Seven studies were included for analysis for post-operative drains and 10 studies were analyzed for primary wound healing. The use of a post-operative drain did not influence healing rates and had no effect secondarily on infection (odds ratio [OR] 1.33; 95% confidence interval [CI] 0.76-2.30). We were not able to establish whether surgical drains prevent hematomas causing neurologic compromise. There was a slight advantage to using occlusive dressings versus non-occlusive dressings in wound healing (OR 2.09; 95% CI 1.44-3.02). Incisional vacuum dressings as both an occlusive barrier and superficial drainage system have shown promise for wounds at risk of dehiscence. There is a relatively high risk of bias in the methodology of many of the studies reviewed. We recommend favoring of occlusive dressings based on heterogeneous and potentially biased evidence. Drain use does not affect wound healing based on similar evidence. Incisional vacuum dressings have shown promise in managing potentially vulnerable wounds.
本研究的目的是系统检索、严格评估和总结已发表的随机对照试验（RCT）和非随机对照试验，这些试验探讨了引流管和敷料对脊柱后路手术伤口愈合率及并发症的影响。术后引流管的使用和术后敷料的类型由主刀医生自行决定，目前尚无可用的临床指南。理论上，引流管可降低术后血肿的发生率，因此，当神经组织暴露时，有可能降低神经功能受损的风险。近年来，有人提倡使用封闭敷料，其可能在术后更长时间内维持无菌屏障。我们对1969年至2013年的数据库进行了系统评价。纳入了所有探讨脊柱手术中引流管及手术伤口一期愈合中敷料的论文。使用Revman（5.2版；北欧Cochrane中心，Cochrane协作网，英国牛津）来检验总体治疗效果、临床异质性和偏倚风险。在检索到的论文中，1348篇探讨了脊柱手术中的术后引流管，979篇涉及所有手术伤口一期愈合的伤口敷料。纳入7项研究分析术后引流管，10项研究分析一期伤口愈合。使用术后引流管对愈合率无影响，对感染也无继发影响（比值比[OR]1.33；95%置信区间[CI]0.76 - 2.30）。我们无法确定手术引流管是否能预防导致神经功能受损的血肿。在伤口愈合方面，使用封闭敷料相对于非封闭敷料有轻微优势（OR 2.09；95%CI 1.44 - 3.02）。切口负压敷料作为一种封闭屏障和浅表引流系统，已显示出对有裂开风险伤口的应用前景。在所审查的许多研究方法中，存在相对较高的偏倚风险。基于异质性和潜在有偏倚的证据，我们建议优先选择封闭敷料。基于类似证据，引流管的使用不影响伤口愈合。切口负压敷料在处理可能易出现问题的伤口方面已显示出应用前景。
