中国修复重建外科杂志

中国修复重建外科杂志

超声骨刀在颈椎后路单开门椎管扩大成形术中的应用

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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(C 3~7)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(P>0.05),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(P<0.05),B、C 组间比较差异无统计学意义(P>0.05)。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 C 5 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(P<0.05);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(P>0.05)。 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。

Objective To investigate the safety and reliability of ultrasonic bone curette in posterior cervical single open-door laminoplasty. Methods The clinical data were retrospectively analyzed, from 193 patients who underwent single open-door laminoplasty (C 3–7) from January 2012 to January 2016. The patients were divided into three groups according to different instruments: posterior single open-door laminoplasty was performed with ultrasonic bone curette in 61 cases (group A), with bite forceps in 73 cases (group B), and with micro-grinding drill in 59 cases (group C). There was no significant difference in gender, age, the course of disease, underlying disease and preoperative Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS) between groups (P>0.05). The operative time, intraoperative blood loss, drainage volume at 48 hours, JOA score, improvement rate, VAS and perioperative com-plication were compared. Results The operative time, intraoperative blood loss, and drainage volume at 48 hours of group A were significantly less than those in groups B and C (P<0.05), but there was no significant between groups B and C (P>0.05). The follow-up time was 12-21 months (mean, 14.6 months) in group A, 24-36 months (mean, 27.5 months) in group B, and 28-47 months (mean, 38.1 months) in group C. There were no cerebrospinal fluid leakage and incision infection in three groups. No complications of internal fixation loosening and rupture occurred during the follow-up. Rediating pain occurred in 6 cases of group A, 8 cases of group B, and 6 cases of group C, and was cured at 1 week after dehydration and physical therapy. No nerve root palsy was found in three groups. Fracture of portal axis occurred in 5 cases (7 segments) of group B and was fixed by micro titanium plate. The JOA score and VAS score at last follow-up were significantly improved when compared with preoperative scores in three groups (P<0.05); there was no significant difference in JOA score and improvement rate and VAS score between groups (P>0.05). Conclusion It is safe and reliable to use the ultrasonic bone curette in posterior cervical single open-door laminoplasty. It can shorten the operative time and has similar clinical curative effect to the traditional operation, and the lateral rotation of the lamina can be avoided.

关键词: 脊髓型颈椎病; 椎管扩大成形术; 超声骨刀; 磨钻

Key words: Cervical spondylotic myelopathy; cervical laminoplasty; ultrasonic bone curette; drill

引用本文: 李玉伟, 王海蛟, 崔巍, 李程, 周鹏, 张永辉. 超声骨刀在颈椎后路单开门椎管扩大成形术中的应用. 中国修复重建外科杂志, 2017, 31(6): 683-689. doi: 10.7507/1002-1892.201702002 复制

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