加速康复外科理念在脊髓型颈椎病手术中应用的临床研究

目的:评价加速康复外科理念在脊髓型颈椎病手术中的作用。方法 :对2012年1月至2015年12月收治的55例脊髓型颈椎病患者的临床资料进行回顾性分析,男30例,女25例;年龄36~71(45.2±3.2)岁;病程1~12(4.5±1.8)个月。其中有35例患者将加速康复外科理念应用在手术治疗及围手术期管理中(研究组),同期手术治疗的20例患者作为对照组(在手术治疗及围手术期管理中未系统应用加速康复外科理念)。手术方式采用前路颈椎间盘切除减压融合内固定(ACDF)38例,后路行单开门椎管扩大成形减压术(单开门)17例。比较两组患者的术后离床活动时间、住院天数;术前、术后1、7、30 d和术后6、12个月分别以日本骨科协会(JOA)评分和视觉模拟评分(visual analogue score,VAS)评估神经功能和疼痛改善情况。结果:所有患者获得随访,时间12~18(14.3±1.5)个月。两组患者在年龄、性别、手术方式、术前JOA评分、VAS评分等方面比较,差异无统计学意义(P0.05)。研究组患者术后离床活动时间3~8(5.54±1.54)h;术后住院天数3~12(5.62±1.59)d;对照组术后离床活动时间24~48(18.80±4.78)h;术后住院天数为7~17(9.85±1.94)d;两组比较差异有统计学意义(P0.01)。两组术后1、7、30 d的JOA评分、VAS评分比较,差异有统计学意义(P0.01)。两组术后6、12个月的JOA评分和VAS评分比较差异无统计学意义(P0.05)。研究组患者住院和随访期间无神经功能恶化、血肿、切口感染、内固定松动等并发症;对照组出现2例切口浅表感染,经换药2周愈合;但两组比较差异无统计学意义(P0.05)。结论:加速外科康复理念运用于脊髓型颈椎病的手术治疗,能够促进患者早期康复,缩短术后住院时间,提高患者对手术的满意度。

Clinical study of the application of enhanced recovery after surgery in cervical spondylotic myelopathy

Objective:To evaluate the role of enhanced recovery after surgery in treating cervical spondylotic myelopathy.Methods:The clinical data of 55 patients with cervical spondylotic myelopathy underwent surgical treatment from January 2012 to December 2015 were retrospectively analyzed. There were 30 males and 25 females,age from 36 to 71 years old with an average of (45.2±3.2) years,course of disease was for 1 to 12 months with an average of (4.5±1.8) months. The concept of enhanced recovery after surgery and perioperative management were applied to surgical treatment in 35 patients (study group),and the same period,20 patients without strategy of enhanced recovery after surgery (control group). Thirty-eight patients were treated by anterior cervical discectomy decompression and fixation(ACDF),17 patients were treated by posterior single-open door laminoplasty decompression. The activity time out of bed,hospitalization days after surgery were compared between two groups. Japanese Orthopaedic Association (JOA) score and visual analogue score(VAS) before operation,after operation at 1,7,30 days and 6,12 months was respectively used to evaluate the neurological function and pain.Results:All the patients were followed up for 12 to 18 months with an average of (14.3±1.5) months. There was no significant difference in age,gender,surgical methods,preoperative VAS,JOA score between two groups (P>0.05). The activity time out of bed was 3 to 8 h with an average of (5.54±1.54) h,postoperative hospitalization time was 3 to 12 d with an average of (5.62±1.59) d in study group,while in control group,the activity time out of bed was 24 to 48 h with an average of (18.80±4.78) h,and postoperative hospitalization time was 7 to 17 d with an average of (9.85±1.94) d;there was significant difference between two groups (P<0.01). There was significant difference in VAS and JOA scores between two groups at 1,7,30 d after operation (P<0.01),and there was no significant difference at 6,12 months after operation(P>0.05). There were no neurologic function deterioration,hematoma,wound infection,internal fixation loosening and other complications in study group during hospitalization and following-up;there were 2 cases of superficial wound infection in the control group,who healed by dressing change for 2 weeks;there was no significant difference between two groups(P>0.05).Conclusion:The strategy of enhanced recovery after surgery in treating cervical spondylotic myelopathy can promote the early recovery,shorten the length of stay and improve the patient''s degree of satisfaction.