Hao Qing-Ying, Liu Chu-Yin, Fu Chan-Juan, Zhang Xiao-Hua, Tan Ming-Sheng
Department of Spinal Surgery, -Japan Friendship Hospital, Beijing 100029, China.
Graduate School, Beijing University of Chinese Medicine, Beijing 100029, China.
Chin Med J (Engl). 2016 Dec 5;129(23):2804-2809. doi: 10.4103/0366-6999.194639.
Continuous negative pressure drainage (CNPD) is widely used after lower lumbar internal fixation; however, it may cause tremendous blood loss and lead to postoperative hemorrhagic anemia. The present study explored the efficacy and safety of improved intermittent-clamped drainage (ICD) for lower lumbar internal fixation.
This was a prospective study that included 156 patients with decompression of the spinal canal and internal fixation for the first time from January 2012 to December 2014. The patients were randomly divided into ICD group and CNPD group, and each group had 78 cases. A drainage tube was placed under the deep fascia in all patients within 10 min after the commencement of wound closure. The postoperative drainage amount at different time points, the hemoglobin level, and postoperative complications were recorded and compared between the two groups. Shapiro-Wilk test, independent samples t-test, and Mann-Whitney U-test were used in this study.
The drainage amount was significantly reduced in the ICD group, as compared with the CNPD group (Z = 10.74, P < 0.01). The mean total drainage amount (in ml) of the single-segment and two-segment procedures was significantly greater in the CNPD group than the ICD group (Z = 10.63 and 10.75, respectively; P < 0.01). For the adverse events, there was no significant difference in postoperative temperature, wound problem, and complications between the two groups.
The present study showed a statistically significant reduction in postoperative drainage amount between ICD and CNPD groups, and ICD is an effective, convenient, and safe method for routine use in lower lumbar surgery. It is essential to focus on the effect of clamping drainage with long-segment surgical procedure and complex lumbar disease in the further investigation, as well as the effect of clamping on long-term functional outcomes.
持续负压引流（CNPD）在下腰椎内固定术后广泛应用；然而，它可能导致大量失血并引发术后出血性贫血。本研究探讨改良间歇性夹闭引流（ICD）在下腰椎内固定术中的疗效和安全性。
这是一项前瞻性研究，纳入了2012年1月至2014年12月首次行椎管减压及内固定的156例患者。患者被随机分为ICD组和CNPD组，每组78例。所有患者在伤口缝合开始后10分钟内在深筋膜下放置引流管。记录并比较两组不同时间点的术后引流量、血红蛋白水平及术后并发症。本研究采用Shapiro-Wilk检验、独立样本t检验和Mann-Whitney U检验。
与CNPD组相比，ICD组的引流量显著减少（Z = 10.74，P < 0.01）。CNPD组单节段和双节段手术的平均总引流量（毫升）显著高于ICD组（分别为Z = 10.63和10.75；P < 0.01）。对于不良事件，两组术后体温、伤口问题及并发症方面无显著差异。
本研究表明，ICD组与CNPD组术后引流量在统计学上有显著减少，ICD是下腰椎手术常规使用的一种有效、便捷且安全的方法。在进一步研究中，必须关注长节段手术和复杂腰椎疾病夹闭引流的效果，以及夹闭对长期功能结局的影响。
