椎间孔镜术后引流管的临床应用初步研究

目的：探究经皮椎间孔镜腰椎间盘切除（percutaneous endoscopic lumbar discectomy，PELD）术后放置引流管的临床意义及相关因素。方法：回顾性分析2019年1月至2019年9月接受PELD手术治疗的151例腰椎间盘突出症患者的临床资料，依据术后是否放置引流管，分为放置引流管组与未放置引流管组，分别于术前、出院时、术后1个月、末次随访观察患者腰腿痛视觉模拟评分（visual analogue scale，VAS）及日本骨科协会（Japanese Orthopaedic Association，JOA）评分，且记录术后引流管放置时间、总引流量；将放置引流管患者年龄、性别、体质量指数、突出节段、吸烟史、合并基础疾病、服用抗凝药物等特征，通过单因素及多因素与PELD术后放置引流管进行分析。结果：共有32例患者PELD术后放置引流管，两组患者术后腰腿痛VAS、JOA评分与术前比较差异有统计学差意义（P<0.05），两组患者在出院时腰腿痛VAS及JOA评分差异有统计学意义（P<0.05），其余时间点评分差异无统计学意义（P>0.05）。单因素分析显示年龄、合并基础疾病及服用抗凝药物与术后放置引流管有关，而性别、体质量指数、突出节段、吸烟史与放置引流管无显著相关性。多因素分析显示高龄，合并高血压、糖尿病及服用抗凝药物与术后放置引流管相关。结论：椎间孔镜术后放置引流管可以早期改善患者腰腿痛症状，对于高龄，合并高血压、糖尿病及服用抗凝药物的患者椎间孔镜术后可以考虑放置引流管。

Research on the clinical application of drainage tube after the operation of percutaneous endoscopic lumbar discectomy

Objective: To investigate the clinical significance and related factors of drainage tube after percutaneous endoscopic lumbar discectomy(PELD).Methods: The clinical data of 151 patients with lumbar disc herniation who underwent PELD from January 2019 to September 2019 was retrospectively analyzed. According to whether the drainage tube was used after operation,the patients were divided into drainage tube group and non drainage tube group. The placement time and total drainage volume were recorded. The characteristics of patients,such as age,gender,body mass index,lumbar disc herniation segment,smoking history,basic diseases and whether taking anticoagulants,were analyzed by single factor and multiple factor.Results: Drainage tubes were used in 32 patients after PELD. There were statistical differences in visual analogue scale(VAS) and Japanese Orthopaedic Assiciation(JOA) scores between postoperative and preoperative of that in two groups(P<0.05). There were statistical differences in VAS and JOA scores at discharge between two groups(P<0.05),while there were no statistical differences at other time points(P>0.05). Univariate analysis showed that age,basic diseases and whether taking anticoagulants were related to the use of drainage tube,but gender,body mass index,lumbar disc herniation segment and smoking history were not significantly related to the use of drainage tube. Multivariate analysis showed that elderly patients,complicated with hypertension and diabetes,taking anticoagulants were related to the use of drainage tube.Conclusion: The use of drainage tube after percutaneous endoscopic lumbar discectomy can improve the symptoms of lumbar and leg pain in early stage. For elderly patients with hypertension, diabetes and taking anticoagulants drugs,drainage tube can be considered after transforaminal endoscopy.