超声骨刀在腰椎管狭窄症椎板切除术中的疗效分析  

Clinical application analysis of ultrasonic osteotome in operation of lumbar spinal stenosis

作　　者：马浩浩 高延征 张敬乙 盛伟超 杨光 MA Hao-hao;GAO Yan-zheng;ZHANG Jing-yi;SHENG Wei-chao;YANG Guang(Department of Spinal cord Surgery,People’s Hospital of Zhengzhou University,Henan Provicial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院(河南省人民医院)脊柱脊髓外科,郑州450003

出　　处：《医药论坛杂志》2020年第1期13-15,19,共4页Journal of Medical Forum

基　　金：河南省科技攻关计划项目(162102310018)。

摘　　要：目的分析超声骨刀在腰椎管狭窄症全椎板切除术中应用的效果。方法回顾性分析郑州大学人民医院2016年7月-2018年12月确诊为腰椎管狭窄症并行腰椎后路椎板切除植骨融合内固定术(posterior lumber interbody fusion,PLIF)治疗的153例患者的临床资料。其中,超声骨刀组78例,传统工具组75例(传统骨刀+椎板咬骨钳)。分析并比较两组患者全椎板切除时间、术中出血量、术后引流量、JOA改善率、VSA改善率、术中有无神经根损伤或马尾损伤、有无硬膜囊损伤或脑脊液漏、术后住院日等情况。结果超声骨刀组与传统手术相比,操作时间、术中出血量、术后引流量及术后住院日均有显著性差异(均P<0.05);两组在JOA评分和VSA评分的改善率上差异无统计学意义(均P>0.05)。超声骨刀组有1例患者出现脑脊液漏,1例患者出现神经根损伤,传统工具组有8例患者出现脑脊液漏,3例患者出现神经根损伤。结论进行腰椎后路椎板切除植骨融合内固定术(posterior lumber interbody fusion,PLIF)术中使用超声骨刀可显著缩短手术时间,减少手术出血,缩短患者住院时间并能避免硬膜囊损伤及脑脊液漏的发生,临床疗效满意。Objective To analyze the effect of ultrasonic osteotome in the operation of lumbar spinal stenosis.Methods The clinical data of 153 patients diagnosed with lumbar spinal stenosis and had posterior lumbar interbody fusion(PLIF)were retrospectively analyzed from July 2016 to December 2018.Among them,78 cases of ultrasonic osteotome group and 75 cases of traditional tool group(traditional bone knife+laminectomy rongeur).Analysis and comparison of total laminectomy time,intraoperative blood loss,postoperative drainage,JOA improvement rate,VSA improvement rate,intraoperative nerve root injury or horsetail injury,presence or absence of dural sac injury or cerebrospinal fluid leakage Waiting for the situation.Results Compared with traditional surgery,the operation time,intraoperative blood loss,postoperative drainage and hospitalization time were significantly different(P<0.05).There was no improvement on JOA score and VSA score in the two groups.Significant differences(both P>0.05).In the ultrasonic osteotome,1 patient had cerebrospinal fluid leakage,1 patient had nerve root injury,8 patients had cerebrospinal fluid leakage in the traditional tool group,and 3 patients had nerve root injury.Conclusion Ultrasound osteotome for posterior lumber interbody fusion(PLIF)can significantly shorten the operation time,reduce the bleeding,shorten the hospital stay and avoid the dural sac.The occurrence of injury and cerebrospinal fluid leakage is satisfactory.

关 键 词：超声骨刀 腰椎管狭窄症 神经根损伤 

分 类 号：R681.5[医药卫生—骨科学]