超声骨刀在腰椎管狭窄症后路减压术中的应用  

Application of the Ultrasonic Osteotome in Lumbar Spinal Stenosis Posterior Operative Decompression

作　　者：潘大洋 邹伟[1] 肖杰[1] 龙浩[1] 冯明星[1] 周昌俊[1] PAN Da-yang;ZOU Wei;XIAO Jie(Department of spine surgery,the 4th People*s hospital of Guiyang city,Guiyang,Guizhou 550002)

机构地区：[1]贵阳市第四人民医院,贵州贵阳550005

出　　处：《中国伤残医学》2022年第9期5-10,共6页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:比较超声骨刀与传统椎板咬骨钳、骨刀在腰椎管狭窄症后路PILF方式减压椎体间融合术.中的临床疗效与安全性。方法:研究对象为64例明确诊断为腰椎管狭窄症手术患者,时间从2019年8月-2020年10月,随机选取34例(观察组)采取超声骨刀行全椎板切除治疗,另外34例(对照组)则采取椎板咬骨错、骨刀。为排除手术节段数目及手术时间长短差异性,2组患者单节段与双节段减压的病例数相同。对比2组患者年龄、身高、体质量,差异无统计学意义(P>0.05)。记录并统计2组病例全椎板切除时间、术中出血量、术后伤口引流量、术中硬膜损伤或破裂例数、术后并发症、术后腰腿疼痛缓解及腰背功能好转情况,对统计数据进行分析比较;术后1周患者腰腿疼痛情况用疼痛视觉模拟评分(VAS)进行;依据Oswestry功能障碍指数(ODI)评分,评估术后1个月腰背部功能改善情况。结果:观察组术中出血量、术后伤口引流量均较对照组少,全椎板切除效率上高于对照组;观察组创缘整齐,对骨质破坏少,小关节损伤相对较小;观察组患者术中无硬膜损伤或破裂发生。对照组3例患者出现硬膜损伤或破裂及1例术后硬膜外血肿形成,术后腰退疼痛缓解及腰背功能恢复情况无明显差异。结论:2种方式的临床疗效相似。然而超声骨刀能减少术中出血量和术后伤口引流量和提高全椎板切除效率,降低硬膜损伤或破裂发生,术中安全性更高,是一种安全、高效的手术方式。Objective:To compare the clinical efficacy and safety of ultrasonic osteotome with traditional laminar rongeur and osteotome in lumbar spinal stenosis posterior lumbar interbody fusion(PILF)decompression.Methods:A total of 64 patients who were clearly diagnosed as lumbar spinal stenosis from August 2019 to October 2020 were randomly selected as research objects.34 cases(group A)were randomly selected for laminectomy with ultrasonic osteotome.Results:34 cases(group B)were treated with laminar rongeur and osteotome.In order to exclude the difference in the number of surgical segments and the duration of surgery,the number of cases with single-segment decompression and double-segment decompression in the two groups was consistent.There were no significant differences in age,height and weight of patients between group A and group B(P>0•05)•The laminectomy time,intraoperative blood loss,postoperative wound drainage,intraoperative dural injury or rupture cases,postoperative complications,postoperative pain relief and improvement of back function were recorded and counted,and the statistical data were analyzed and compared.One week after operation,the waist and leg pain of patients was measured by visual analog>r score(VAS).According to Oswestry disability index(ODI)score,the improvement of lumbar back function one month after operation was evaluated.Results The amount of intraoperative hemorrhage and postoperative wound drainage in group A were less than those in group B,and the efficiency of laminectomy was higher than that in group B.In group A,the wound margin was neat,the damage to bone was less,and the damage to facet joints was relatively small.There was no dural injury or rupture in group A,3 patients with dural injury or rupture and 1 patient with epidural hematoma formation in group B.There was no significant difference in relief of lumbar pain and recovery of lumbar back function after operation.Conclusion:The clinical efficacy of the two methods are similar.However,ultrasonic osteotome can reduce intraop

关 键 词：腰椎管狭窄 推板切除 超声骨刀 

分 类 号：R681[医药卫生—骨科学]