Aims Closed suction subfascial drainage is widely used after instrumented posterior spinal fusion in patients with a spinal deformity. The aim of this study was to determine the effect of this wound drainage on the outcomes in patients with adolescent idiopathic scoliosis (AIS). This was a further analysis of a randomized, multicentre clinical trial reporting on patients after posterior spinal fusion using segmental pedicle screw instrumentation. In this study the incidence of deep surgical site infection (SSI) and chronic postoperative pain at two years' follow-up are reported. Methods We conducted a randomized, multicentre clinical trial on adolescents undergoing posterior spinal fusion for AIS using segmental pedicle screw instrumentation. A total of 90 consecutive patients were randomized into a 'drain' or 'no drain' group at the time of wound closure, using the sealed envelope technique (1:1). The primary outcomes in the initial study were the change in the level of haemoglobin in the blood postoperatively and total blood loss. A secondary outcome was the opioid consumption immediately after surgery. The aim of this further study was to report the rate of deep SSI and persistent postoperative pain, at two years' follow-up. Results As previously reported, the mean 48-hour opioid consumption was significantly higher in the no drain group (2.0 mg/kg (SD 0.8) vs 1.4 mg/kg (SD 0.7); p = 0.005). There were no delayed deep SSIs. At two years' follow-up, the mean Scoliosis Research Society 24-item questionnaire (SRS-24) total score did not differ between the groups (4.11 (SD 0.47) vs 4.16 (SD 0.33); p = 0.910). The mean SRS-24 pain score was 4.28 (SD 0.48) in the no drain group compared with 4.33 (SD 0.66) in the drain group (p = 0.245). Seven patients (19%) in the no drain group and six in the drain group (14%) reported moderate to severe pain (numerical rating scale ≥ 4) at two years' follow-up (p = 0.484). The general self-image domain score was significantly higher in the no drain group compared with the drain group (4.02 (SD 0.74) vs 4.59 (SD 0.54); p < 0.001). Conclusion The main finding in this study was that more severe pain immediately after surgery did not result in a higher incidence of chronic pain in the no drain group compared with the drain group. Back pain and health-related quality of life at two years' follow-up did not differ between the groups. The patient-reported self-image domain was significantly better in the no drain group compared with the drain group.

中文翻译：

---

封闭式抽吸伤口引流对青少年特发性脊柱侧凸患者脊柱后路融合术后慢性疼痛和健康相关生活质量的影响。


目的 闭式抽吸筋膜下引流在脊柱畸形患者的器械脊柱后路融合后广泛使用。本研究的目的是确定这种伤口引流对青少年特发性脊柱侧凸 （AIS） 患者预后的影响。这是对一项随机、多中心临床试验的进一步分析，该试验报告了使用节段性椎弓根螺钉器械进行脊柱后路融合术后的患者。在这项研究中，报告了两年随访时深部手术部位感染 （SSI） 和慢性术后疼痛的发生率。方法 我们对使用节段性椎弓根螺钉器械接受后路脊柱融合治疗 AIS 的青少年进行了一项随机、多中心临床试验。共有 90 名连续患者在伤口闭合时被随机分配到“引流”或“无引流”组，使用密封包膜技术 （1：1）。初步研究的主要结局是术后血红蛋白水平的变化和总失血量。次要结果是手术后立即消耗阿片类药物。这项进一步研究的目的是报告两年随访时深度 SSI 和持续性术后疼痛的发生率。结果如前所述，无引流组的平均 48 小时阿片类药物消耗量显着更高 （2.0 mg/kg （SD 0.8） vs 1.4 mg/kg （SD 0.7）;p = 0.005）。没有延迟的深部 SSI。在两年的随访中，脊柱侧凸研究学会 24 项问卷 （SRS-24） 平均总分在两组之间没有差异 （4.11 （SD 0.47） vs 4.16 （SD 0.33）;p = 0.910）。无引流组的平均 SRS-24 疼痛评分为 4.28 （SD 0.48），而引流组为 4.33 （SD 0.66） （p = 0.245）。 无引流组 7 例患者 （19%） 和引流组 6 例 （14%） 报告在两年随访时出现中度至重度疼痛 （数字评定量表 ≥ 4） （p = 0.484）。与引流组相比，无引流组的一般自我图像域评分显著更高 （4.02 （SD 0.74） vs 4.59 （SD 0.54）;p < 0.001）。结论 本研究的主要发现是，与引流组相比，术后更剧烈的疼痛并不会导致无引流组慢性疼痛的发生率更高。两年随访时，背痛和健康相关生活质量在两组之间没有差异。与引流组相比，无引流组患者报告的自我图像域显著更好。