Federal State Budgetary Institution Russian Ilizarov Scientific Center for "Restorative Traumatology and Orthopaedics", Ministry of Healthcare, Russian Federation, Kurgan, Russia.
Scientific and Clinical Laboratory of Axial Skeleton Pathology and Neurosurgery, Head of Trauma and Orthopedic Dept. No 10, Federal State Budgetary Institution Russian Ilizarov Scientific Center for "Restorative Traumatology and Orthopaedics", Ministry of Healthcare, Russian Federation, Kurgan, Russia.
Eur Spine J. 2019 Jan;28(1):146-154. doi: 10.1007/s00586-018-5791-x. Epub 2018 Oct 11.
To explore the role of closed suction drain in multi-level posterior spinal surgery.
We performed prospective, open-label, randomised control, superiority trial with parallel design and 1:1 allocation. A total of 161 patients undergoing posterior spinal surgery involving more than one motion segment at a dedicated spine surgery department were randomly allocated into "drain" or "no-drain" groups, based on which surgical drain was employed at the end of surgery. After excluding six cases with intraoperative dural tear, the data of 80 patients in "drain" and 75 patients in "no-drain" group were analysed. Primary outcome was total perioperative blood loss (sum of intraoperative blood loss, volume of drain if present and volume aspirated if patient developed collection in relation to surgical wound). The secondary outcomes were transfusion requirements, wound healing and complications.
Both groups were comparable with respect to baseline characteristics. Total perioperative blood loss was significantly higher in "drain" group (716 ± 312.97 ml vs 377.9 ± 295.72 ml, p < 0.0001). Number and volume of post-operative aspirations were significantly higher in "no-drain" group whereas transfusion requirements were significantly higher in "drain" group. Except for one case of superficial wound inflammation in either group, there were no complications. Subgroup analysis revealed that the results were applicable for surgeries involving "two/three" levels and "more than three" levels.
The practice of not using closed surgical drains after multi-level posterior spinal surgery reduces post-operative blood loss and transfusion requirements. But this comes with the disadvantage of increased wound soakage and need for post-operative wound aspirations. The risks of benefits of "drain" and "no drain" must be carefully weighed and an informed choice be taken. These slides can be retrieved under Electronic Supplementary Material.
探讨后路多节段脊柱手术后应用闭式引流的作用。
我们开展了前瞻性、开放性标签、随机对照、优效性平行设计试验，采用 1:1 随机分组。在一个专门的脊柱外科病房，对接受后路脊柱手术且涉及 1 个以上运动节段的 161 例患者，根据术中是否使用引流管进行术后引流，将其分为“引流”或“非引流”组。排除 6 例术中硬脊膜撕裂的病例后，分析 80 例引流组和 75 例非引流组患者的资料。主要结局为总围手术期失血量（术中失血量、引流管引流量和手术伤口相关的积液抽吸量之和）。次要结局为输血需求、伤口愈合和并发症。
两组基线特征相当。引流组总围手术期失血量明显更高（716±312.97ml 比 377.9±295.72ml，p<0.0001）。非引流组术后抽吸次数和量明显更多，而引流组输血需求更高。两组各有 1 例出现伤口浅表炎症，均无其他并发症。亚组分析显示，结果适用于涉及“两个/三个”节段和“三个以上”节段的手术。
后路多节段脊柱手术后不使用闭式引流管可减少术后失血量和输血需求。但这会增加伤口浸湿和术后伤口抽吸的需求。必须仔细权衡“引流”和“非引流”的风险和获益，并做出知情选择。这些幻灯片可在电子补充材料中获取。
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