超声骨刀在颈椎后路单开门椎管扩大成形术中的应用
发布时间：2018-10-08 08:10
【摘要】：目的探讨超声骨刀应用于颈椎后路单开门椎管扩大成形术的安全性及疗效。方法回顾分析2012年1月—2016年1月,收治的符合选择标准的193例行颈椎后路单开门椎管扩大成形术(C3~7)患者临床资料。根据术中使用器械不同分为3组:应用超声骨刀61例(A组),应用三关节咬骨钳及椎板咬骨钳73例(B组),应用微型磨钻59例(C组)。3组患者性别、年龄、病程、合并基础疾病及术前日本骨科协会(JOA)评分、疼痛视觉模拟评分(VAS)比较,差异均无统计学意义(P0.05),具有可比性。记录并比较3组手术时间、术中出血量、术后48 h引流量、JOA评分及改善率、VAS评分以及围术期并发症发生情况。结果 A组手术时间、术中出血量及术后48 h引流量均显著少于B、C组(P0.05),B、C组间比较差异无统计学意义(P0.05)。3组患者均获随访,A组随访时间12~21个月,平均14.6个月;B组24~36个月,平均27.5个月;C组28~47个月,平均38.1个月。3组术后均未发生脑脊液漏、切口感染,随访期间无内固定物松动、脱出、断裂等并发症发生。A组6例、B组8例、C组6例出现肩部放射痛,给予脱水剂、物理治疗等处理,1周后疼痛均消失。3组均未出现C5神经根麻痹。A、C组均未出现门轴断裂;B组5例7个门轴发生断裂,予以微型钛板固定。末次随访时,3组JOA评分及VAS评分均较术前显著改善(P0.05);3组间JOA评分及改善率以及VAS评分比较,差异均无统计学意义(P0.05)。结论采用超声骨刀行颈椎单开门椎管扩大成形术安全可靠、手术时间短,临床疗效与传统手术操作相似,可避免椎板门轴侧断裂。
[Abstract]:Objective to evaluate the safety and efficacy of ultrasonic bone knife in posterior cervical open door laminoplasty. Methods from January 2012 to January 2016, 193 patients with posterior open door laminoplasty (C3F7) were retrospectively analyzed. According to the different instruments used during operation, the patients were divided into three groups: 61 cases were treated with ultrasonic bone knife (group A), 73 cases were treated with triarticular rongeur and laminar forceps (group B), 59 cases were treated with micro-grinding drill (group C). There was no significant difference in (JOA) score and pain visual analogue score (VAS) between basic diseases and preoperative Japanese orthopedic Association (P0.05). The operative time, intraoperative bleeding volume, JOA score, improvement rate and VAS score and perioperative complications were recorded and compared among the three groups. Results the time of operation, the amount of blood loss during operation and the drainage flow at 48 hours after operation in group A were significantly less than those in group B (P0.05). There was no significant difference between group C and group C (P0.05). The follow-up time of group A was 12 ~ 21 months (mean 14.6 months), and that of group B was 24 ~ 36 months. There was no cerebrospinal fluid leakage, incision infection, and no internal fixation loosening, extubation, rupture and other complications occurred in group A (n = 6), group B (n = 8) and group C (n = 6). After 1 week of treatment with dehydrating agent and physical therapy, the pain disappeared in all the groups. No C5 nerve root palsy was found in group 3. In group A, there was no rupture of portal axis in group B, and in group B, there was no rupture of portal axis in 5 cases and 7 cases in group B were fixed with micro titanium plate. At the last follow-up, the JOA scores and VAS scores of the three groups were significantly improved compared with the preoperative ones (P0.05). There was no significant difference in the JOA score and the improvement rate and the VAS score between the three groups (P0.05). Conclusion it is safe and reliable to use ultrasonic bone knife to open the open cervical vertebra canal expansion surgery, the operation time is short, the clinical curative effect is similar to the traditional operation, can avoid the lamina portalis axial fracture.
【作者单位】： 漯河医学高等专科学校第一附属医院脊柱科;
【分类号】：R687.3
本文编号：2256049
[Abstract]:Objective to evaluate the safety and efficacy of ultrasonic bone knife in posterior cervical open door laminoplasty. Methods from January 2012 to January 2016, 193 patients with posterior open door laminoplasty (C3F7) were retrospectively analyzed. According to the different instruments used during operation, the patients were divided into three groups: 61 cases were treated with ultrasonic bone knife (group A), 73 cases were treated with triarticular rongeur and laminar forceps (group B), 59 cases were treated with micro-grinding drill (group C). There was no significant difference in (JOA) score and pain visual analogue score (VAS) between basic diseases and preoperative Japanese orthopedic Association (P0.05). The operative time, intraoperative bleeding volume, JOA score, improvement rate and VAS score and perioperative complications were recorded and compared among the three groups. Results the time of operation, the amount of blood loss during operation and the drainage flow at 48 hours after operation in group A were significantly less than those in group B (P0.05). There was no significant difference between group C and group C (P0.05). The follow-up time of group A was 12 ~ 21 months (mean 14.6 months), and that of group B was 24 ~ 36 months. There was no cerebrospinal fluid leakage, incision infection, and no internal fixation loosening, extubation, rupture and other complications occurred in group A (n = 6), group B (n = 8) and group C (n = 6). After 1 week of treatment with dehydrating agent and physical therapy, the pain disappeared in all the groups. No C5 nerve root palsy was found in group 3. In group A, there was no rupture of portal axis in group B, and in group B, there was no rupture of portal axis in 5 cases and 7 cases in group B were fixed with micro titanium plate. At the last follow-up, the JOA scores and VAS scores of the three groups were significantly improved compared with the preoperative ones (P0.05). There was no significant difference in the JOA score and the improvement rate and the VAS score between the three groups (P0.05). Conclusion it is safe and reliable to use ultrasonic bone knife to open the open cervical vertebra canal expansion surgery, the operation time is short, the clinical curative effect is similar to the traditional operation, can avoid the lamina portalis axial fracture.
【作者单位】： 漯河医学高等专科学校第一附属医院脊柱科;
【分类号】：R687.3
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1 刘昊;新型超声骨刀应用于椎间孔成形术的研究[D];苏州大学;2016年
2 郑家春;超声骨刀技术在颈椎胸椎手术中的应用[D];山东大学;2014年
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