中国修复重建外科杂志

中国修复重建外科杂志

颈后路椎板切除减压术中应用超声骨刀的安全性和疗效评估

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目的 探讨在颈后路椎板切除减压术中应用超声骨刀的安全性及对手术疗效的影响。 方法 回顾分析 2013 年 4 月—2017 年 4 月 52 例因颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament of cervical spine,C-OPLL)行颈椎后路椎板扩大切除减压植骨融合术(posterior cervical laminectomy decompression and fusion,PCLDF)患者临床资料。按术中是否使用超声骨刀分为超声骨刀组(A 组,20 例)和传统枪式钳减压手术组(B 组,32 例)。两组患者性别、年龄、体质量、身高、术前血红蛋白及日本骨科协会(JOA)评分等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者手术时间、术中出血量、术后引流量、住院时间、并发症发生情况、术后 1 d 血红蛋白、术后 6 个月 JOA 评分,并计算 JOA 改善率。 结果 A 组手术时间及术中出血量显著少于 B 组(P<0.05);两组术后引流量及住院时间比较差异无统计学意义(P>0.05)。两组术后 1 d 血红蛋白均较术前显著改善(P<0.05);术后 1 d B 组血红蛋白略高于 A 组,但差异无统计学意义(t=–1.260,P=0.214)。两组患者均获随访,随访时间 6~10 个月,平均 7.6 个月。所有患者术中及术后均无 C5 神经麻痹、硬膜撕裂、感染、硬膜外血肿形成、深静脉血栓形成、肺栓塞、输血过敏、休克等严重并发症发生。两组术后 6 个月 JOA 评分均较术前改善(P<0.05);术后 6 个月两组间 JOA 评分及改善率比较,差异均无统计学意义(P>0.05)。 结论 PCLDF 治疗 C-OPLL 术中使用超声骨刀安全可靠,减压效果与传统枪式钳一致,但具有明显缩短手术时间以及减少术中出血的优势。

Objective To explore the safety of ultrasonic osteotome used in posterior cervical surgery and its effect on surgical outcome. Methods The clinical data of 52 patients with ossification of posterior longitudinal ligament of cervical spine (C-OPLL) undergoing posterior cervical laminectomy decompression and fusion (PCLDF) between April 2013 and April 2017 were retrospectively analysed. The patients were divided into two groups according to whether using the ultrasonic osteotome during operation: group A (20 cases, ultrasonic osteotome group) and group B (32 cases, traditional gun-clamp decompression group). There was no significant difference in gender, age, body weight, height, preoperative hemoglobin, and Japanese Orthopedic Association (JOA) score between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, hospitalization time, complications, hemoglobin at 1 day after operation, and JOA score at 6 months after operation were recorded and compared between the two groups, and the improvement rate of JOA was calculated. Results The operation time and intraoperative blood loss in group A were significantly less than those in group B (P<0.05); there was no significant difference in the drainage volume and hospitalization time between the two groups (P>0.05). The hemoglobin of group B was slightly higher than that of group A at 1 day after operation, but there was no significant difference between the two groups (t=–1.260, P=0.214). All the patients were followed up 6-10 months (mean, 7.6 months). No serious complications such as C5 nerve paralysis, dural tear, infection, epidural hematoma, deep venous thrombosis, pulmonary embolism, transfusion allergy, or shock occurred during and after operation. The JOA scores of the two groups were significant improved at 6 months after operation when compared with preoperative scores (P<0.05), and there was no significant difference in JOA score and improvement rate between the two groups at 6 months after operation (P>0.05). Conclusion Compared with the traditional gun-clamp decompression, the effectiveness of PCLDF treatment of C-OPLL surgery by using ultrasonic osteotome is comparable, but the latter can effectively reduce the operation time and blood loss.

关键词: 超声骨刀; 颈椎后路椎板扩大切除减压植骨融合术; 颈椎后纵韧带骨化

Key words: Ultrasonic osteotome; posterior cervical laminectomy decompression and fusion; ossification of posterior longitudinal ligament of cervical spine

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