超声骨刀及椎板成形术应用于椎管内肿瘤手术的临床分析

发布时间：2018-05-14 17:22

  本文选题：超声骨刀 + 椎管内肿瘤　； 参考：《吉林大学》2017年硕士论文

【摘要】：目的:研究在32例椎管内肿瘤切除术中应用超声骨刀与传统咬骨钳的效果比较,观察术后骨性愈合及神经功能恢复情况,并分析超声骨刀在安全性及可靠性方面的影响因素。方法:回顾性分析2015年9月至2016年9月于吉林大学第一医院神经肿瘤外科住院的患者中行椎管内肿瘤切除手术的患者共32例,分为超声骨刀组(16例)、咬骨钳组(16例),入组患者均按美国脊柱损伤协会(ASIA)分级标准在术前评估脊神经的功能情况。所有患者均由本医疗组带组教授及副教授级神经外科医师实施手术,超声骨刀组术中采用超声骨刀行椎板后路切开,处理完椎管内肿瘤后再将卸下的棘突椎板复合体以钛板、钛钉固定,完成原位回植、实现椎管成形。咬骨钳组术中采用咬骨钳行传统棘突椎板咬除术式,暴露手术部位硬脊膜,处理完椎管内肿瘤后无椎管成形操作。记录全部患者的一般资料及临床表现,分别统计两组患者硬脊膜充分暴露所需时间、硬脊膜暴露过程手术出血量、术中硬脊膜损伤情况、术前术后3~6个月脊髓神经功能恢复情况(ASIA分级)及骨质愈合情况(超声骨刀组)。对研究结果采用SPSS 18.0进行统计学分析,比较两组患者术中情况、出院后骨愈合及功能恢复情况。结果:本研究共顺利实施椎管内肿瘤切除术32例,超声骨刀组在术中及术后骨愈合方面表现出较明显优势,其术中完全暴露硬脊膜过程中出血量少于咬骨钳组(P0.05),未增加硬脊膜损伤率,远期神经功能得到良好恢复(ASIA分级)。另外,虽然总样本中暴露硬脊膜的手术时间二者差异无统计学意义(P0.05),但是当切除脊椎节段≥5时,超声骨刀组能够比咬骨钳组更明显地缩短手术时间、减少出血量。术中超声骨刀体现出切割精度高、操作效率高、手部疲劳性低、手术出血少、术野清晰、对软组织保护好等优势,特别适用于多节段椎管内肿瘤手术的椎板切除。术后3~6个月超声骨刀组部分患者回植的棘突椎板复合体出现骨性愈合,1例发生轻度医源性椎管狭窄,但患者无明显神经卡压症状。结论:超声骨刀作为一种新型手术器械,能够安全有效地切除棘突椎板复合体,能缩短手术时间、减少出血量,其组织选择性、热效应和空化效应能够在手术过程中很好的保护神经血管等软组织,并且超声骨刀可以更方便地实现棘突椎板复合体的原位回植,对术后重建脊柱解剖结构及后期脊柱稳定性的维持具有重要临床意义。故应用超声骨刀联合棘突椎板回植术可在椎管内肿瘤手术中推广。
[Abstract]:Objective: to compare the effect of ultrasonic bone knife and traditional bone biting forceps in 32 cases of intraspinal tumor resection, to observe the recovery of bone healing and nerve function after operation, and to analyze the influencing factors of safety and reliability of ultrasonic bone knife. Methods: from September 2015 to September 2016, 32 patients who underwent intraspinal tumor resection in the Department of Neurooncology, first Hospital of Jilin University, were retrospectively analyzed. The patients were divided into ultrasonic scalpel group (n = 16) and bone-biting forceps group (n = 16). All the patients in the group were assessed the function of spinal nerve before operation according to the ASIA classification standard of American Spinal injury Association. All the patients were operated by professor and associate professor in our medical group. In the ultrasonic bone knife group, the posterior laminectomy was performed with ultrasonic bone knife, and the spinous process laminar complex was removed with titanium plate after the treatment of the tumor in the spinal canal. Titanium nail fixation, complete in situ replantation, to achieve spinal canal formation. In the bone biting forceps group, the traditional spinous process laminectomy was performed with bone biting forceps, which exposed the dura mater of the operation site, and had no spinal canal formation operation after the treatment of the tumors in the spinal canal. The general data and clinical manifestations of all the patients were recorded. The time required for full dural exposure, the amount of operative bleeding during dural exposure, and the intraoperative dural injury were counted. The recovery of spinal cord nerve function before and after 3 ~ 6 months after operation was assessed by Asia grade and bone healing (ultrasonic bone knife group). The results of the study were analyzed by SPSS 18.0. The intraoperative conditions, bone healing and functional recovery were compared between the two groups. Results: 32 cases of intraspinal tumor resection were performed successfully in this study. The ultrasonic bone knife group showed obvious advantages in bone healing during and after operation. The amount of blood lost during the operation was less than that in the bone-biting forceps group (P 0.05), but the rate of dural injury was not increased, and the long term nerve function was well recovered by Asia classification. In addition, although there was no significant difference between the two groups in the operation time of dural exposure in the total sample, when the spinal segment was 鈮，

本文编号：1888800