超声骨刀与高速磨钻在颈椎后路全椎板切除减压手术应用中的比较研究

发布时间：2018-06-18 03:44

本文选题：后纵韧带骨化 + 超声骨刀　；参考：《中国脊柱脊髓杂志》2017年06期

【摘要】：目的:比较超声骨刀和高速磨钻在颈椎后纵韧带骨化症伴椎管狭窄行后路全椎板切除减压手术中的安全性与有效性。方法:回顾分析2013年9月~2016年12月确诊为颈椎后纵韧带骨化伴椎管狭窄症行颈椎后路全椎板切除减压结合侧块/椎弓根螺钉内固定的患者53例。其中超声骨刀组(A组)24例,共切除椎板101个节段。高速磨钻组(B组)29例,共切除椎板124个节段。观察记录两组患者术中全椎板切除时间、手术过程中单节段椎板切除平均出血量、围手术期并发症(脊髓损伤、神经根损伤、硬膜囊损伤、脑脊液漏等),JOA评分及改善率。术后评估两组患者神经症状及并发症情况。结果:两组患者的年龄、性别比、术前JOA评分和减压节段数差异均无统计学意义(P0.05)。A组患者平均单个节段全椎板截骨时间为1.7±1.1min(1.4~3.3min),低于B组的2.9±1.8min(1.9~5.6min)(P0.05),手术过程中两组单节段椎板切除平均出血量为52.4±36.5ml(35.1~285.6ml)和60.3±34.2ml(41.1~281.4ml),两组比较无显著性差异(P0.05)。A、B组JOA评分分别由术前9.3±3.1分提高到术后12.7±2.0分和术前9.1±3.4分提高到术后12.9±2.8分,P0.05。两组患者术后JOA评分均明显优于术前(P0.05),但两组JOA改善率(分别为45.6%和51.2%)比较,差异无统计学意义(P0.05)。两组患者均未出现脊髓、神经根及硬膜囊损伤,无截骨操作相关并发症发生。结论:超声骨刀和高速磨钻均能安全有效地完成颈椎OPLL后路全椎板切除减压手术,在减轻术者工作强度、不增加出血及并发症的同时,超声骨刀能有效缩短全椎板切除时间。
[Abstract]:Objective: to compare the safety and efficacy of ultrasonic bone knife and high speed grinding drill in posterior laminectomy and decompression of posterior longitudinal ligament ossification with spinal canal stenosis. Methods: from September 2013 to December 2016, 53 patients with posterior longitudinal ligament ossification combined with spinal canal stenosis underwent posterior laminectomy and decompression combined with lateral mass / pedicle screw fixation. Among them, 24 cases were treated with ultrasonic bone knife group and 101 segments of vertebral lamina were resected. A total of 124 segments of vertebral lamina were resected in group B (n = 29). The time of total laminectomy during operation, the average amount of blood loss during single segment laminectomy, the perioperative complications (spinal cord injury, nerve root injury, dural sac injury, cerebrospinal fluid leakage, etc.) and the improvement rate were observed and recorded. The neurological symptoms and complications were evaluated after operation. Results: the age, sex ratio of the two groups, There was no significant difference in preoperative JOA score and the number of decompression segments. The mean total lamina osteotomy time of group A was 1.7 卤1.1 min ~ 1.43.3min, which was lower than that of group B (2.9 卤1.8min ~ 1.9min ~ 5.6min). The mean blood loss during operation was 52.4 卤36.5ml / 35.1ml) and 60.3 卤34.2ml / 41.1ml / 281.4ml / ml. There was no significant difference in JOA score between the two groups from 9.3 卤3.1 to 12.7 卤2.0 and 9.1 卤3.4 to 12.9 卤2.8 and 12.9 卤2.8 respectively (P 0.05). The JOA scores of the two groups were significantly better than those of the patients before operation (P 0.05), but there was no significant difference in the improvement rate of JOA between the two groups (45.6% and 51.2%, respectively). No spinal cord, nerve root and dural sac injury were found in both groups. Conclusion: ultrasonic bone knife and high speed grinding drill can both safely and effectively complete the decompression and decompression of the posterior approach of cervical vertebrae total laminectomy. The ultrasonic bone knife can effectively shorten the time of total laminectomy without increasing bleeding and complications while reducing the working intensity of the operation.
【作者单位】：无锡市第九人民医院脊柱外科;第二军医大学附属长海医院脊柱外科;
【分类号】：R687.3

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