Jang Hae-Dong, Park Seong San, Kim Kyungbum, Kim Eung-Ha, Lee Jae Chul, Choi Sung-Woo, Shin Byung-Joon
Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
Global Spine J. 2023 Apr;13(3):621-629. doi: 10.1177/21925682211001801. Epub 2021 Mar 18.
A retrospective case-control study.
The usefulness of a drain in spinal surgery has always been controversial. The purposes of this study were to determine the incidence of hematoma-related complications after posterior lumbar interbody fusion (PLIF) without a drain and to evaluate its usefulness.
We included 347 consecutive patients with degenerative lumbar disease who underwent single- or double-level PLIF. The participants were divided into 2 groups by the use of a drain or not; drain group and no-drain group.
In 165 cases of PLIF without drain, there was neither a newly developed neurological deficit due to hematoma nor reoperation for hematoma evacuation. In the no-drain group, there were 5 (3.0%) patients who suffered from surgical site infection (SSI), all superficial, and 17 (10.3%) patients who complained of postoperative transient recurred leg pain, all treated conservatively. Days from surgery to ambulation and length of hospital stay (LOS) of the no-drain group were faster than those of the drain group ( < 0.001). In a multiple regression analysis, a drain insertion was found to have a significant effect on the delayed ambulation and increased LOS. No significant differences existed between the 2 groups in additional surgery for hematoma evacuation, or SSI.
No hematoma-related neurological deficits or reoperations caused by epidural hematoma and SSI were observed in the no-drain group. The no-drain group did not show significantly more frequent postoperative complications than the drain use group, hence the routine insertion of a drain following PLIF should be reconsidered carefully.
一项回顾性病例对照研究。
脊柱手术中引流管的作用一直存在争议。本研究的目的是确定后路腰椎椎间融合术（PLIF）不使用引流管时血肿相关并发症的发生率，并评估其作用。
我们纳入了347例连续接受单节段或双节段PLIF的退行性腰椎疾病患者。参与者根据是否使用引流管分为两组；引流管组和无引流管组。
在165例未使用引流管的PLIF病例中，既没有因血肿导致的新发神经功能缺损，也没有因血肿清除而进行的再次手术。在无引流管组中，有5例（3.0%）患者发生手术部位感染（SSI），均为浅表感染，17例（10.3%）患者抱怨术后短暂复发性腿痛，均采用保守治疗。无引流管组从手术到下床活动的天数和住院时间（LOS）比引流管组更快（<0.001）。在多元回归分析中，发现插入引流管对延迟下床活动和住院时间延长有显著影响。两组在血肿清除或SSI的额外手术方面没有显著差异。
在无引流管组中未观察到与血肿相关的神经功能缺损或由硬膜外血肿和SSI引起的再次手术。无引流管组术后并发症的发生率并不显著高于使用引流管组，因此应仔细重新考虑PLIF术后常规插入引流管的做法。
