超声引导下穿刺引流治疗脊柱术区血肿的临床疗效研究

摘要/Abstract

摘要： 目的回顾性探讨超声引导下穿刺引流对治疗脊柱术区血肿的临床疗效。方法选择2020年1月~2022年7月西安兵器工业五二一医院收治的164例脊柱手术后术区发生血肿的患者为研究对象,对临床治疗方式进行回顾性分析,按照治疗方式分为超声下穿刺引流组（25例）、盲穿引流组（37例）和保守治疗组（102例）。手术后比较分析3组患者治疗有效率、术后住院天数、症状持续时间。结果术后第1天、第5天超声下穿刺引流组、盲穿引流组患者的有效率明显高于保守治疗组,差异有统计学意义（P<0.05）;超声下穿刺引流组、盲穿引流组患者术后住院天数、症状持续时间均显著低于保守治疗组,差异有统计学意义（P<0.05）;超声下穿刺引流组与盲穿引流组的有效率、术后住院天数、症状持续时间相比,差异无统计学意义（P>0.05）。结论超声引导下穿刺引流术具有安全、微创、有效等优点,且疗效显著高于保守治疗,是脊柱术后血肿治疗的首选方法。

关键词: 脊柱, 术区血肿, 超声, 穿刺引流, 临床疗效

Abstract: Objective To investigate the clinical effect of ultrasound-guided puncture and drainage on spinal hematoma. Methods 164 cases of hematoma in the operative area after spinal surgery admitted to Xi ‘an 521 Hospital of Ordnance Industry from January 2020 to July 2022 were selected as the research objects. The clinical treatment methods were retrospectively analyzed. According to the treatment methods, the patients were divided into ultrasound guided drainage group （n=25）, blind perforation drainage group （n=37） and conservative treatment group （n=102）. The effective rate, postoperative hospital stay and symptom duration of the three groups were compared and analyzed after operation. Results On the 1st and 5th day after operation, the effective rate of patients in ultrasound puncture and drainage group and blind puncture and drainage group was significantly higher than that in conservative treatment group （P<0.05）. The postoperative hospital stay and symptom duration of patients in ultrasound puncture drainage group and blind puncture drainage group were significantly lower than those in conservative treatment group, and the differences were statistically significant （P<0.05）. There were no significant differences in the effective rate, postoperative hospital stay and symptom duration between the two groups （P>0.05）. Conclusion Ultrasound guided puncture and drainage is safe, minimally invasive and effective, meanwhile the curative effect is significantly higher than that of conservative treatment. It is the first choice for the treatment of spinal hematoma after spinal surgery.

Key words: spine, surgical area of hematoma, ultrasound, puncture and drainage, clinical efficacy

中图分类号:

R455.1

于湖, 段小艺. 超声引导下穿刺引流治疗脊柱术区血肿的临床疗效研究[J]. 中华养生保健, 2022, 40(22): 158-160.

YU Hu, DUAN Xiao-yi. Clinical Study of Ultrasound-Guided Puncture and Drainage in the Treatment of Spinal Hematoma[J]. ZHONGHUA YANGSHENG BAOJIAN, 2022, 40(22): 158-160.

参考文献

[1] Reidy J, Mobbs R.Spinal Subdural Hematoma: Rare Complication of Spinal Decompression Surgery[J]. World Neurosurg, 2022, 158:114-117.
[2] Oichi Y, Toda H, Yamagishi K, et al.Multiple Spinal Chronic Subdural Hematomas Associated with Thoracic Hematomyelia: A Case Report and Literature Review[J]. World Neurosurg, 2019, 131:95-103.
[3] Chimenti P, Molinari R.Post-operative spinal epidural hematoma causing American Spinal Injury Association B spinal cord injury in patients with suction wound drains[J]. J Spinal Cord Med, 2013,36(3):213-219.
[4] Shin W S, Ahn D K, Lee J S, et al.The Influence of Antiplatelet Drug Medication on Spine Surgery[J]. Clin Orthop Surg, 2018, 10(3):380-384.
[5] 邱海洋,张扬,雷伟.脊柱减压术后症状性硬膜外血肿形成的影响因素分析[J].颈腰痛杂志,2021,42(6):797-800.
[6] 王立飞,李显博,王春雷,等.腰椎后路术后症状性脊柱硬脊膜外血肿的研究进展[J].实用骨科杂志,2018,24(5):438-440.
[7] Rudy H L, Cho W, Oster B A, et al.Treatment of Isolated Serosanguinous Incision Drainage after Thoracolumbar Surgery: Is Surgical Management Always Necessary[J]. Surg Infect (Larchmt), 2020, 21(3):227-230.
[8] Ridwan S, Grote A, Simon M.Safety and Efficacy of Negative Pressure Wound Therapy for Deep Spinal Wound Infections After Dural Exposure, Durotomy, or Intradural Surgery[J]. World Neurosurg, 2020, 134:e624-e630.
[9] Blank J, Flynn J M, Bronson W, et al.The use of postoperative subcutaneous closed suction drainage after posterior spinal fusion in adolescents with idiopathic scoliosis[J]. J Spinal Disord Tech, 2003,16(6): 508-512.
[10] Jeyakumar A, Weaver J J, Chick J F B, et al. Spinal ultrasound after failed landmarked-based lumbar puncture: a single institutional experience[J]. Pediatr Radiol, 2021, 51(2):289-295.
[11] 沈忆新,周晓中.脊柱手术后硬脊膜外血肿诊治方法[J].中华外科杂志,2009,47(2):154-155.
[12] 叶小伟,刘少强,曾培洪,等.脊柱术后症状性硬膜外血肿早期诊断和合理防治的研究进展[J].中华外科杂志,2017,55(11):877-880.
[13] 金壮,曹军英,张筠,等.超声引导下穿刺置管引流术治疗脊柱术后术区血肿研究[J].临床军医杂志,2018,46(1):16-18.
[14] 周宇,陈淳,邓发斌,等.不同剂量阿托伐他汀对慢性硬膜下血肿的疗效及安全性评价[J].中国药房,2017,28(5):663-667.
[15] Kim J E, Choi D J, Kim M C, et al.Risk Factors of Postoperative Spinal Epidural Hematoma After Biportal Endoscopic Spinal Surgery[J]. World Neurosurgery, 2019,129:324-329.
[16] Heiner J D. Cervical epidural hematoma after chiropractic spinal manipulation[J]. Am J Emerg Med, 2009, 27(8):1023.e1-2.
[17] Bodilsen J, Mariager T, Vestergaard H H, et al.Association of Lumbar Puncture With Spinal Hematoma in Patients With and Without Coagulopathy[J]. JAMA, 2020, 324(14):1419-1428.
[18] Mirzai H, Eminoglu M, Orguc S.Are drains useful for lumbar disc surgery A prospective, randomized clinical study[J]. J Spinal Disord Tech, 2006, 19(3):171-177.
[19] 董志辉,徐建杰,张斌,等.腰椎术后应用低分子肝素抗凝与硬膜外血肿形成的关联性研究[J].颈腰痛杂志,2015,36(2):138-140.
[20] 付滨,齐磊,肖天科,等.超声引导下穿刺与传统盲穿对脊柱侧弯患者的疗效对比[J].血管与腔内血管外科杂志,2022,8(5):627-630.