超声骨刮匙在C_(7)穹隆减压手术中的应用  

Application of Ultrasonic Bone Curette in C_(7) Dome Decompression During Cervical Laminoplasty

作　　者：陈卓 杨易远 刘泽祥 屈若木 吴云霞[1] 姜亮[1] Chen Zhuo;Yang Yiyuan;Liu Zexiang(Department of Orthopedics,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科,北京100191

出　　处：《中国微创外科杂志》2022年第12期934-938,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：北京大学第三医院临床重点项目(BYSYZD2019005)。

摘　　要：目的探讨颈椎椎板成形术中应用超声骨刮匙(ultrasonic bone curette,UBC)进行C_(7)穹窿减压的安全性和有效性。方法2019年9月~2020年6月我科应用UBC行C_(4~6)椎板成形、C_(3)椎板切除、C_(7)穹隆减压椎板成形术,观察患者手术前后日本骨科学会(Japanese Orthopedic Association,JOA)评分、生活质量量表(Short Form 36,SF-36)评分、颈椎功能障碍指数(Neck Disability Index,NDI)评分及影像学表现。结果手术时间(115.0±29.9)min(77~182 min),术中出血量50~300 ml(中位数150 ml)。术后住院时间平均5.1 d(3~9 d)。术后均未发生脑脊液漏、神经损伤和出血。40例随访平均18.6月(12~21个月),末次随访JOA评分从术前(12.0±2.4)分提高到(14.9±1.8)分(t=-20.597,P=0.000)。SF-36评分从术前(23.2±5.0)分提高到(26.5±3.8)分(t=-13.344,P=0.000);NDI评分从术前中位数13.5(2~34)分降低到3.5(0~30)分(Z=-5.521,P=0.000);C_(2~7)Cobb角由术前13.6°±5.7°下降到12.0°±5.8°(t=6.467,P=0.000);C 2~7颈椎活动度从术前37.0°±9.1°下降到31.0°±6.6°(t=13.244,P=0.000);C_(7)棘突到椎体的最小径线从术前(9.2±2.2)mm提高到(12.8±1.9)mm(t=-39.622,P=0.000)。结论颈后路C_(7)椎板穹隆减压术中应用UBC安全、有效。Objective To investigate the safety and efficacy of a specialized ultrasound bone curette(UBC)in C_(7) dome decompression during cervical laminoplasty.Methods Clinical data of 40 patients who underwent C_(4-6) laminoplasty,C_(3) laminectomy,and C_(7) dome decompression with the use of a UBC from September 2019 to June 2020 were retrospectively analyzed.Patients’Japanese Orthopedic Association(JOA)score,Short Form 36(SF-36)general life status score,neck disability index(NDI)score,and radiographic data were extracted and analyzed.Results The operation time was(115.0±29.9)min(range,77-182 min),and the median blood loss during the operation was 150 ml(range,50-300 ml).No patient experienced unintentional durotomy,neurological injury,or postoperative hematoma.The mean follow-up time was 18.6 months(range,12-21 months).The JOA scores increased from(12.0±2.4)points to(14.9±1.8)points(t=-20.597,P=0.000),the SF-36 scores increased from(23.2±5.0)points to(26.5±3.8)points(t=-13.344,P=0.000),and the median NID scores decreased from 13.5 points(range,2-34 points)to 3.5 points(range,0-30 points)(Z=-5.521,P=0.000).The C_(2-7) Cobb angle decreased from 13.6°±5.7°preoperatively to 12.0°±5.8°at the final follow-up(t=6.467,P=0.000).The C_(2-7) range of motion decreased from 37.0°±9.1°to 31.0°±6.6°(t=13.244,P=0.000).The sagittal spinal canal diameter of C_(7) significantly increased from(9.2±2.2)mm to(12.8±1.9)mm(t=-39.622,P=0.000).Conclusion Application of UBC in C_(7) dome decompression is safe and effective and may be considered a useful alternative to traditional tools.

关 键 词：C_(7)穹隆减压术 超声骨刮匙 椎板成形术 脊髓型颈椎病 

分 类 号：R687.3[医药卫生—骨科学]