腰椎斜侧入路椎间融合术的围手术期护理(1)
摘 要：目的 探讨斜侧入路腰椎椎间融合术治疗腰椎退行性疾病的围手术期护理要点。方法 回顾性分析2017年7月～2018年1月因腰椎退行性疾病于我科行OLIF手术治疗的40例患者临床资料及护理措施，针对性总结该术式围手术期的护理特点，对比住院当天和术后出院时ODI评分、VAS评分和脊柱生活质量量表得分。结果 40例患者均顺利完成OLIF手术，所有患者术后腰腿痛症状均得到不同程度缓解。术后ODI评分、VAS评分和脊柱生活质量量表得分分别为(19.18±5.10)分、(1.98±0.53)分、(53.20±7.88)分，均优于术前的(28.30±6.61)分、(4.63±1.03)分、(63.40±6.83)分，差异具有统计学意义(P<0.05)。结论 OLIF是一种安全有效治疗腰椎退变性疾病的微创手术方法，完善全面的围手术期护理是保证手术安全、提高手术疗效的重要因素。
关键词：斜侧入路腰椎椎间融合術；腰椎退行性疾病；围手术期护理
中图分类号：R473.6 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.15.053
, 百拇医药
文章编号：1006-1959(2018)15-0161-03
Perioperative Nursing of Lumbar Interbody Fusion via Oblique Lateral Approach
LUO Kun，XU Shu-juan，ZHANG Hong
(Department of Spinal Orthopaedics，Yijishan Hospital，Wannan Medical College，Wuhu 241001，Anhui，China)
Abstract：Objective To explore the perioperative nursing of oblique lumbar interbody fusion in the treatment of lumbar degenerative diseases.Methods The clinical data and nursing measures of 40 patients undergoing OLIF operation for lumbar degenerative diseases from July 2017 to January 2018 were analyzed retrospectively，and the nursing features of the perioperative period were summarized. The ODI score，VAS score and the spinal quality of life scale were compared on the day of hospitalization and at the time of discharge.Results OLIF was successfully performed in all the 40 patients，and the symptoms of lumbago and leg pain were relieved to some extent.The scores of ODI score and Spine Quality of Life Scale were(19.18±5.10)，(1.98±0.53)，(53.20±7.88)，higher than those before operation(28.30±6.61)，(4.63±1.03)，(63.40±6.83)，respectively，the difference was statistically significant(P<0.05).Conclusion OLIF is a safe and effective minimally，invasive method for the treatment of lumbar degenerative diseases.The improvement of perioperative nursing is an important factor to ensure the operation safety and improve the curative effect.
, 百拇医药
Key words：Oblique lumbar interbody fusion；Lumbar degenerative disease；Perioperative nursing
腰椎退行性疾病(lumbar degenerative disease)是脊柱外科的常见病、多发病，包括腰椎间盘突出症、腰椎管狭窄症以及腰椎滑脱症等。目前临床较多采用经后路腰椎椎间融合术进行治疗，但是此种手术方式需要对患者腰背部软组织进行广泛的剥离，创伤较大，术后并发症较多，患者恢复时间较长。近年来，斜侧入路腰椎椎间融合术(oblique lumbar interbody fusion，OLIF)作为一种新型的微创手术术式，因其整体操作步骤较其他术式简便、手术时间短、患者术中失血量少、术后恢复快而逐渐受到越来越多临床医生的认可[1]。皖南医学院弋矶山医院自2017年7月起对40例腰椎退行性疾病患者开展了OLIF手术治疗，并通过围手术期予以完善细致的护理和宣教，取得了良好的治疗效果，现将护理经验和体会报道如下。
, 百拇医药
1资料与方法
1.1一般资料 选择2017年7月～2018年1月于皖南医学院弋矶山医院脊柱骨科接受OLIF手术治疗的腰椎退行性疾病患者共40例，男16例，女24例；年龄34～85岁，平均年龄(61.73±11.57)岁，其中腰椎间盘突出症10例，腰椎椎管狭窄症17例，腰椎滑脱症11例，退变性脊柱侧弯2例。所有患者均具有急慢性腰背痛病史，伴或不伴下肢神经压迫症状，保守治疗半年以上无效，严重影响患者生活和工作，采取手术治疗。5例行L3/4、L4/5双节段椎间融合，1例行L2/3、L4/5双节段椎间融合，2例行L4/5单节段椎间融合+椎弓根内固定术，2例行L3/4单节段椎间融合，余皆为L4/5单节段椎间融合。术前所有患者均常规行腰椎正侧位X线摄片、腰椎CT和MRI检查。腰椎正侧位平片和腰椎CT能够观察腰椎曲度变化、腰椎滑脱以及局部骨质增生情况，腰椎MRI可帮助定位手术节段，并进一步明确手术层面腹膜后血管鞘与腰大肌之间的间隙宽度，初步估算手术节段椎间盘的横径以指导术中选择合适大小的椎间融合器。, 百拇医药(罗琨 徐姝娟 章洪)
关键词：斜侧入路腰椎椎间融合術；腰椎退行性疾病；围手术期护理
中图分类号：R473.6 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.15.053
, 百拇医药
文章编号：1006-1959(2018)15-0161-03
Perioperative Nursing of Lumbar Interbody Fusion via Oblique Lateral Approach
LUO Kun，XU Shu-juan，ZHANG Hong
(Department of Spinal Orthopaedics，Yijishan Hospital，Wannan Medical College，Wuhu 241001，Anhui，China)
Abstract：Objective To explore the perioperative nursing of oblique lumbar interbody fusion in the treatment of lumbar degenerative diseases.Methods The clinical data and nursing measures of 40 patients undergoing OLIF operation for lumbar degenerative diseases from July 2017 to January 2018 were analyzed retrospectively，and the nursing features of the perioperative period were summarized. The ODI score，VAS score and the spinal quality of life scale were compared on the day of hospitalization and at the time of discharge.Results OLIF was successfully performed in all the 40 patients，and the symptoms of lumbago and leg pain were relieved to some extent.The scores of ODI score and Spine Quality of Life Scale were(19.18±5.10)，(1.98±0.53)，(53.20±7.88)，higher than those before operation(28.30±6.61)，(4.63±1.03)，(63.40±6.83)，respectively，the difference was statistically significant(P<0.05).Conclusion OLIF is a safe and effective minimally，invasive method for the treatment of lumbar degenerative diseases.The improvement of perioperative nursing is an important factor to ensure the operation safety and improve the curative effect.
, 百拇医药
Key words：Oblique lumbar interbody fusion；Lumbar degenerative disease；Perioperative nursing
腰椎退行性疾病(lumbar degenerative disease)是脊柱外科的常见病、多发病，包括腰椎间盘突出症、腰椎管狭窄症以及腰椎滑脱症等。目前临床较多采用经后路腰椎椎间融合术进行治疗，但是此种手术方式需要对患者腰背部软组织进行广泛的剥离，创伤较大，术后并发症较多，患者恢复时间较长。近年来，斜侧入路腰椎椎间融合术(oblique lumbar interbody fusion，OLIF)作为一种新型的微创手术术式，因其整体操作步骤较其他术式简便、手术时间短、患者术中失血量少、术后恢复快而逐渐受到越来越多临床医生的认可[1]。皖南医学院弋矶山医院自2017年7月起对40例腰椎退行性疾病患者开展了OLIF手术治疗，并通过围手术期予以完善细致的护理和宣教，取得了良好的治疗效果，现将护理经验和体会报道如下。
, 百拇医药
1资料与方法
1.1一般资料 选择2017年7月～2018年1月于皖南医学院弋矶山医院脊柱骨科接受OLIF手术治疗的腰椎退行性疾病患者共40例，男16例，女24例；年龄34～85岁，平均年龄(61.73±11.57)岁，其中腰椎间盘突出症10例，腰椎椎管狭窄症17例，腰椎滑脱症11例，退变性脊柱侧弯2例。所有患者均具有急慢性腰背痛病史，伴或不伴下肢神经压迫症状，保守治疗半年以上无效，严重影响患者生活和工作，采取手术治疗。5例行L3/4、L4/5双节段椎间融合，1例行L2/3、L4/5双节段椎间融合，2例行L4/5单节段椎间融合+椎弓根内固定术，2例行L3/4单节段椎间融合，余皆为L4/5单节段椎间融合。术前所有患者均常规行腰椎正侧位X线摄片、腰椎CT和MRI检查。腰椎正侧位平片和腰椎CT能够观察腰椎曲度变化、腰椎滑脱以及局部骨质增生情况，腰椎MRI可帮助定位手术节段，并进一步明确手术层面腹膜后血管鞘与腰大肌之间的间隙宽度，初步估算手术节段椎间盘的横径以指导术中选择合适大小的椎间融合器。, 百拇医药(罗琨 徐姝娟 章洪)