3D数字辅助超声骨刀技术在胸椎管黄韧带骨化症中的短期疗效评价  

The Efficacy Analysis of Ultrasonic Bone Curette and 3D Printing and Digital Technique in Surgery of Thoracic Ossification of Ligamentum Flavum

作　　者：蔺啸 杜彦艳 李耀章 白马恒 韩康 王彦东 李卫勤 张伟 LIN Xiao;DU Yan-yan;LI Yao-zhang;BAI Ma-heng;HAN Kang;WANG Yan-dong;LI Wei-qin;ZHANG Wei(Deprtment of orthopedic,Xingyuan Hospital,Yulin,Shaanxi,719000,China;Department of orthopedics,Tangdu Hospital,Air Force Medical University,Xi'an,Shaanxi,710038,China;Department of spinal cord repair,the 960th Hospital of the PLA,Ji'nan,Shandong,250000,China)

机构地区：[1]陕西省榆林市星元(第四)医院骨二科,陕西榆林719000 [2]空军军医大学附属唐都医院骨科,陕西西安710038 [3]解放军第九六〇医院脊髓修复科,山东济南250000

出　　处：《现代生物医学进展》2020年第24期4674-4678,共5页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81702935)。

摘　　要：目的:探讨使用3D数字技术结合超声骨刀技术在胸椎管黄韧带骨化症中的临床疗效和安全性。方法:回顾性分析我院诊断为胸椎管骨化症,在2016.01至2019.01行手术治疗的共计38例患者。根据手术方法的不同,将其分为3D+超声骨刀组(观察组,17例)与磨钻治疗组(对照组,21例)。比较两组患者的如下三大项指标:手术指标(术中出血、椎板切除时间等),疗效指标(术后JOA评分等)及并发症指标(脑脊液漏等)。结果:两组患者在性别、年龄、椎体节段等指标中无统计学差异(P>0.05)。3D+超声骨刀组患者在出血量,椎板切除时间等指标中,显著优于对照组,存在统计学差异(P<0.05)。两组患者在术后JOA评分较手术前均有显著改善(P<0.05),且3D+超声骨刀组显著优于对照组。3D+超声骨刀组中出现4例脑脊液漏患者,而对照组中出现8例脑脊液漏患者。两组患者间无显著性差异(P>0.05)。其中,3D+超声骨刀组中未出现器械损伤硬膜者,对照组中有2例出现器械损伤硬膜。结论:与传统的磨钻技术相比,使用3D打印技术+超声骨刀技术能够在提高临床疗效的同时,缩短手术时间与术中出血,并且具备较好的安全性。Objective:To investigate the safety and efficacy of the ultrasonic bone curette in the operation of thoracic ossification of ligamentum flavum,and the advantages of technology than the traditional high-speed drill.Methods:From 2016.01 to 2019.01,38 cases of thoracic ossification of ligamentum flavum were divided into two groups according to operation method.17 patients received treatment with ultrasonic bone curette and 3 D printing and digital technique,while 21 patients underwent surgery by high-speed drill.The lamina excision time,blood loss,the hospital length of stay(LOS)and the rate of complications such as dural injury and cerebrospinal fluid leakage were noted,and postoperative JOA score and the rate of postoperative neurological improvement were followed.Results:There was no significant difference between 2 groups on sex,age and average vertebral segment(P>0.05).The patients treated with ultrasonic bone curette and 3 D printing and digital technique had better results in operation time and blood lose(P<0.05).The JOA score of two groups were significant improved after operation and there were significant difference between 2 groups(P<0.05).There were 4 cases of dural injury or cerebrospinal fluid leakage in observe group and 8 in control group.There was no significant difference between 2 groups(P>0.05).Among,0 cases and 2 cases were found of equipment damage in observe group and control group respectively.Conclusions:Comparing the high-speed drill in decompression.,using the ultrasonic bone curette and 3 D printing and digital technique can significantly reduced the operation time and the bleeding amount while improve the clinic effect and no add the risk.

关 键 词：黄韧带骨化 脑脊液漏 超声骨刀 磨钻 

分 类 号：R681.5文献标识码:A[医药卫生—骨科学]