超声骨刀在颈椎病后路椎管减压手术中的应用  

Application of ultrasonic osteotome in posterior decompression of cervical spondylopathy

作　　者：张圣飞[1] 张亮[1] 杨建东[1] 张志强[1] 蔡俊[1] 陶玉平[1] 冯新民[1] ZHANG Sheng-fei;ZHANG Liang;YANG Jian-dong(Subei People's Hospital of Jiangsu Province,Yangzhou 225001,China)

机构地区：[1]苏北人民医院,江苏扬州225001

出　　处：《吉林医学》2021年第11期2637-2641,共5页Jilin Medical Journal

摘　　要：目的:探讨超声骨刀在颈椎病后路椎管减压手术中的安全性与有效性。方法:回顾性分析2017年1月~2020年6月脊柱外科行颈椎病后入路椎管减压手术患者,其中应用超声骨刀减压患者(A组)28例,其中单开门组12例(A1组),全椎板切除减压组16例(A2组);应用高速磨钻减压患者(B组)22例,其中单开门组9例(B1组)全椎板切除减压组13例(B2组)。观察并记录患者切除椎板节段数目、切除椎板所需时间、术中总出血量、术后引流量、术中有无硬脊膜撕裂、有无脊髓损伤和神经根损伤、术后有无脑脊液漏及术前术后JOA评分。结果:所有患者均顺利完成手术,均未出现脊髓损伤、神经根损伤等严重并发症。各组患者之间的性别比、年龄、椎板切除节段数目与术前JOA评分比较,差异无统计学意义(均P>0.05)。所有患者术后JOA评分较术前均有显著改善,差异有统计学意义(P<0.05),各组之间术后JOA评分比较,差异无显著统计学意义(P>0.05)。高速磨钻组出现3例硬脊膜撕裂,超声骨刀组出现1例硬脊膜撕裂,术后均出现脑脊液漏,术后第2天拔除引流管后均自行愈合。A1组较B1组、A2组较B2组患者在手术总时间比较,差异无统计学意义(P>0.05)。A1组单节段椎板平均切除时间为(2.08±0.56)min,低于B1组(3.39±0.70)min,差异有统计学意义(P<0.05);A2组单节段椎板平均切除时间为(2.34±0.75)min,低于B2组(3.85±0.83)min,差异有统计学意义(P<0.05)。虽然A1组较B1组、A2组较B2组患者术中总失血量比较,差异无显著统计学意义(P>0.05),但是A1组较B1组、A2组较B2组患者术后引流量均明显减少,差异有统计学意义(P<0.05)。结论:超声骨刀在颈椎后入路椎板切除减压手术中安全且高效,可以节省椎板切除时间、减少出血、减少神经损伤等并发症,有利于患者术后快速康复,同时能够减轻手术者劳动强度,在脊柱外科手术中将会有更广泛的应用价值。Objective To explore the safety and effectiveness of ultrasonic osteotome in posterior spinal canal decompression surgery for cervical spondylosis.Method A retrospective analysis of patients with spinal canal decompression surgery in our hospital from January 2017 to June 2020.Among them,28 patients were treated with ultrasound osteotome decompression(group A),including 12 patients in the single door group(Group A1)Total laminectomy decompression group 16 cases(A2 group),high-speed drill decompression patients(group B)22 cases,of which 9 cases in single door group(B1 group)total laminectomy decompression group 13 Example(Group B2).Observe and record the number of segments removed from the lamina,the time required to remove the lamina,the total amount of blood loss during the operation,the amount of postoperative drainage,whether there is a dural tear during the operation,whether there is spinal cord injury and nerve root injury,and postoperative Whether there is cerebrospinal fluid leakage and JOA score before and after surgery.Results All patients successfully completed the operation without any serious complications such as spinal cord injury and nerve root injury.There were no significant differences in gender ratio,age,number of laminectomy segments,and preoperative JOA score between the groups of patients(P>0.05).The JOA scores of all patients were significantly improved after surgery(P<0.05),and there was still no significant difference in JOA scores between the groups(P>0.05).There were 3 cases of spinal dural tear in the high-speed drill group and 1 case of dural tear in the ultrasonic bone knife group.CSF leakage occurred after the operation,and all healed spontaneously after the drainage tube was removed on the second day after the operation.There was no significant difference in the total operation time between group A1 and group B1,group A2 and group B2(P>0.05).The average single-segment laminectomy time in group A1 was(2.08±0.56)min,which was lower than(3.39±0.70)min in group B1(P<0.05);the average

关 键 词：超声骨刀 高速磨钻 颈椎病 颈椎后路 椎管减压 

分 类 号：R687.3[医药卫生—骨科学]