应用超声骨刀行腰椎后路椎板切除术与传统手术技术的对比研究

发布时间：2018-05-04 20:14

本文选题：超声骨刀 + 椎板切除术　；参考：《中国脊柱脊髓杂志》2017年08期

【摘要】：目的 :探讨应用超声骨刀行腰椎后路椎板切除术的效果及安全性。方法 :总结分析2015年2月~2016年11月由北京大学国际医院完成的腰椎手术病例共计85例,A组为采用超声骨刀行腰椎后路椎板切除的62例患者,其中28例由具备2年脊柱外科手术经验的医师c完成(Ac组),34例由具备25年脊柱外科手术经验的医师d完成(Ad组);B组为采用传统操作器械行腰椎后路椎板切除术的23例患者,其中10例由医师c完成(Bc组),13例由医师d完成(Bd组)。所有病例术前诊断均为腰椎管狭窄症,手术切除腰椎椎板共计119节段,手术方式均采用后路腰椎体间融合术(posterior lumbar interbody fusion,PLIF),实时记录术中椎板切除时间,手术出血量,统计术中硬膜损伤及神经根损伤等并发症发生情况,手术前1d及术后1周行ODI评分评估患者症状缓解情况。结果:A组椎板切除平均耗时分别为3.24±0.80min(Ac组)和3.48±0.82min(Ad组);B组椎板切除平均耗时分别为18.84±4.21min(Bc组)和3.72±1.03min(Bd组),Bc组手术耗时较其他组显著延长(P0.05)。术中出血量、各组手术前后ODI及VAS改善情况无显著统计学差异(P0.05)。A组硬膜损伤2例,B组1例,Ad组神经根损伤1例。结论:采用超声骨刀行腰椎后路椎板切除术具备可行性,应用超声骨刀并没有增加硬膜损伤及神经根损伤的发生率,相对于应用骨刀及椎板咬骨钳等普通器械切除腰椎椎板,超声骨刀技术更加容易掌握,学习曲线更短。
[Abstract]:Objective: to evaluate the effect and safety of posterior lumbar laminectomy with ultrasonic bone knife. Methods: from February 2015 to November 2016, a total of 85 cases of lumbar vertebrae surgery were performed by Peking University International Hospital. Group A received posterior lumbar laminectomy with ultrasonic bone knife. Among them, 28 cases were completed by a physician with 2 years' experience in spinal surgery c and 34 cases in group A (with 25 years of experience in spinal surgery). Group B was treated as 23 patients undergoing posterior lumbar laminectomy with traditional instruments. Among them, 10 cases were completed by doctor c and 13 cases by doctor d. All the patients were diagnosed as lumbar spinal stenosis before operation. The total number of lumbar laminectomy was 119segments. The posterior lumbar interbody fusion was used in all cases. The time of laminectomy and the amount of blood lost during the operation were recorded in real time. The complications such as dural injury and nerve root injury during operation were analyzed. The symptom relief was evaluated by ODI score 1 day before operation and 1 week after operation. Results the average time of laminectomy in group 1: a was 3.24 卤0.80min(Ac) and that in group B was 18.84 卤4.21min(Bc in group C (3.48 卤0.82min(Ad). The time of laminectomy in group B (3.72 卤1.03min(Bd) was significantly longer than that in group B (3.72 卤1.03min(Bd). There was no significant difference in the amount of intraoperative bleeding and the improvement of ODI and VAS before and after operation. In group A, there were 2 cases of dural injury and 1 case of nerve root injury in group B (1 case). Conclusion: it is feasible to use ultrasonic bone knife for posterior lumbar vertebra laminectomy. Ultrasonic bone knife does not increase the incidence of dural injury and nerve root injury, compared with common instruments such as bone knife and laminectomy forceps. Ultrasonic bone knife technology is easier to master, learning curve is shorter.
【作者单位】：北京大学国际医院骨科;
【分类号】：R687.3

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