超声骨刀和高速磨钻在颈椎后路棘突纵割式椎板成形术中的应用比较  

Comparison of ultrasonic osteotome and high-speed drill in posterior cervical spinous process splitting laminoplasty using coralline hydroxyapatite

作　　者：马赛[1] 李楠[1] 何达[1] MA Sai;LI Nan;HE Da(Department of Spine Surgery,Beijing Jishuitan Hospital,Beijing,100035,China)

机构地区：[1]北京积水潭医院脊柱外科,100035

出　　处：《中国骨与关节杂志》2022年第7期504-509,共6页Chinese Journal of Bone and Joint

摘　　要：目的探讨超声骨刀和高速磨钻在颈后路棘突纵割式椎板成形术(spinous process splitting laminoplasty using coralline hydroxyapatite,SLAC)中的临床疗效与安全性。方法回顾性分析2015年6月至2017年9月,于我院确诊为多节段颈椎管狭窄症行SLAC的患者87例。根据术中使用磨削工具种类,分为超声骨刀组(A组,n=48)和高速磨钻组(B组,n=39)。记录两组患者总手术时间、切除C_(3)椎板时间、切除C_(7)头侧椎板时间、侧沟制作时间、术中出血量、围术期并发症(硬膜囊损伤、脑脊液漏、脊髓损伤等),记录术前及术后5天日本骨科协会(Japanese Orthopaedic Association,JOA)评分,JOA评分改善率等。结果两组患者均行C_(3)椎板切除,C_(7)头侧部分椎板切除,C_(4~6)椎板成形,患者年龄、性别比以及术前JOA评分差异均无统计学意义(P>0.05)。A组总手术时间为(91.0±8.7)min,B组为(103.7±11.0)min,差异无统计学意义(P>0.05);A组C_(3)椎板时间为(3.3±0.7)min,显著低于B组的(4.8±1.0)min(P<0.05);A组切除C_(7)椎板时间为(2.9±0.4)min,显著低于B组的(4.1±0.9)min(P<0.05);A组侧沟制作时间为(3.5±0.4)min,显著低于B组的(4.7±0.8)min(P<0.05);两组术中出血量差异无统计学意义[(201.0±68.0)ml vs.(209.0±61.6)ml]。两组患者均未出现术中硬膜撕裂或脊髓损伤,A组出现C_(5)神经根麻痹2例,术后感染1例;B组出现C_(5)神经根麻痹2例。两组患者术后JOA评分均显著优于术前(P<0.05);两组患者JOA改善率差异无统计学意义(P>0.05)。结论SLAC术中使用超声骨刀和高速磨钻均可安全有效完成椎板切除及侧沟制作,超声骨刀可明显缩短主要步骤手术时间,提高手术效率。Objective To investigate the clinical efficacy and safety of spinous process splitting laminoplasty using coralline hydroxyapatite(SLAC)by ultrasonic osteotome or high-speed drill.Methods A series of 87 patients with multilevel cervical spondylotic myelopathy,who were treated with SLAC,were enrolled in this retrospective study from June 2015 to September 2017.They were divided into group A(ultrasonic osteotome group)and group B(high-speed drill group)according to the different grinding tools.There are 48 patients in group A and 39 in group B.Operation time,C_(3)laminectomy time,C_(7)cranial partial laminectomy time,lateral gutter making time,blood loss,perioperative complications(durotomy,cerebrospinal fluid leak,injury of nerve root and spinal cord),preoperative and postoperative 5 days’Japanese Orthopaedic Association(JOA)scores were recorded.Results All patients underwent C_(3)laminectomy,C_(7)cranial partial laminectomy and C_(4-6)laminoplasty.There were no statistical differences in age,sex ratio and preoperative JOA scores between the two groups(P>0.05).The average operation time was(91.0±8.7)min in group A and(103.7±11.0)min in group B,showing no significant differences between the two groups(P>0.05).The average C_(3)laminectomy time in group A was(3.3±0.7)min,which was significantly shorter than that in group B(4.8±1.0 min,P<0.05).The average C_(7)cranial partial laminectomy time in group A was(2.9±0.4)min,which was significantly shorter than that in group B(4.1±0.9 min,P<0.05).The average lateral gutter making time in group A was(3.5±0.4)min,which was significantly shorter than that in group B(4.7±0.8 min,P<0.05).There were no significant differences between the two groups in blood loss(201.0±68.0 ml,209.0±61.6 ml).No durotomy,cerebrospinal fluid leak,injury of nerve root or spinal cord was noted.There were 2 cases with C_(5) palsy in the two groups respectively and 1 case with infection in group A.The postoperative JOA scores were both improved significantly compared with the data preoperati

关 键 词：颈椎 椎管狭窄 椎板成形术 超声骨刀 

分 类 号：R687.3[医药卫生—骨科学]