超声骨刀与咬骨钳在颈椎后路单开门术中应用效果比较  

Comparison the application effect of piezosurgery and rongeur in posterior cervical expansive open-door laminoplasty

作　　者：周兴华[1] 杨敏[2] 李涛[1] 朱利[1] 王博 崔彦彬[1] 

机构地区：[1]保定市第一中心医院骨二科,河北保定071000 [2]保定市第一中心医院综合内科,河北保定071000

出　　处：《临床骨科杂志》2018年第1期11-13,16,共4页Journal of Clinical Orthopaedics

摘　　要：目的比较超声骨刀与咬骨钳在颈椎后路单开门椎管扩大成形术中的应用效果与安全性。方法对89例行颈椎后路单开门椎管扩大成形术患者的临床资料进行分析,其中应用超声骨刀32例(超声骨刀组),应用咬骨钳57例(咬骨钳组)。观察两组开门时间、开门过程中出血量、开门过程中平均每分钟出血量、术后引流量、JOA评分及其改善率、围术期并发症情况等指标。结果手术开门时间、开门过程中出血量、术后引流量超声骨刀组均少于咬骨钳组,差异均有统计学意义(P<0.05)。开门过程中平均每分钟出血量两组比较差异无统计学意义(P>0.05)。两组患者术后神经功能明显改善,术后1周JOA评分均优于术前(P<0.05)。两组患者术后1周JOA评分及JOA评分改善率比较差异无统计学意义(P>0.05)。两组均未出现硬膜撕裂、脑脊液漏及伤口感染患者。结论颈后路单开门椎管扩大成形术中应用超声骨刀具有缩短手术时间、减少开门过程中出血量及术后引流少和相对高效的优点,其安全性和有效性与应用咬骨钳相似。Objective To compare the efficacy and safety of posterior cervical expansive open-door laminoplasty by using piezosurgery versus rongeur. Methods Eighty-nine patients with cervical spondylotic myelopathy underwent posterior cervical expansive open-door laminoplasty by either using piezosurgery （n = 32, the piezosurgevy group） or rongeur （n = 57, the rongeur group）. The clinical data were collected and analyzed retrospectively. The posterior cer- vical open-door time, blood loss during the process of open-door, average per minute blood loss during the process of open-door,postoperative drainage, JOA scores, improvement rate of the JOA scores and incidence of complications were compared between piezosurgery group and rongeur group. Results The open-door time and blood loss during the process of open-door, both showed piezosurgery group was less than those of rongeur group （ P 〈 0. 05 ）. Postoper- ative drainage of piezosurgery group was less than that of rongeur group （ P 〈 0. 05 ）. Average per minute blood loss during the process of open-door were similar between the two groups, which had no statistical significance （P 〉 0. 05 ）. The postoperative neurological function of both groups were significantly improved, JOA scores of 1 week postopera- tion was superior to preoperative ones （ P 〈 0. 05 ）, but there were no statistical differences of postoperative JOA scores after a week, as well as JOA scoring improvement rate between two groups （P 〉 O. 05）. No patients suffered from dural tear leakage of cerebrospinal fluid or wound infection in both groups. Conclusions When compared with rongeur, us- age of piezosurgery can obtain similar safety and effect during posterior cervical expansive open-door laminoplasty, which is relatively more efficient with less postoperative drainage.

关 键 词：颈椎病 椎管扩大成形术 超声骨刀 咬骨钳 

分 类 号：R681.5[医药卫生—骨科学]