학술논문
显微镜辅助下超声骨刀在颈椎前路骨化物切除中的应用及临床疗效 / Application and clinical effect of ultrasonic bone knife under microscope in anterior cervical ossification resection
Document Type
Academic Journal
Author
鲍小明; 张小平; 郭卫东; 赵海恩; 董鑫; 廖博; 任坤; Bao Xiaoming; Zhang Xiaoping; Guo Weidong; Zhao Haien; Dong Xin; Liao Bo; Ren Kun
Source
生物骨科材料与临床研究 / Orthopaedic Biomechanics Materials and Clinical Study. 20(6):27-31
Subject
Language
Chinese
ISSN
1672-5972
Abstract
目的 探讨颈椎前路减压中显微镜下超声骨刀较传统椎板咬钳在颈椎病前路骨化物中的优缺点及临床疗效比较.方法 回顾性分析空军军医大学第二附属医院2017年5月至2019年6月行颈椎前路减压融合手术的32例患者,18例为超声骨刀组,14例为枪钳减压组.评估两组患者的手术时间、术中失血量、术后引流量、住院时间、并发症、神经功能JOA评分、NDI指数及影像学椎管占位率、颈椎Cobb角及融合率.结果 两组患者均顺利完成手术,随访12～24个月,平均(16.18±3.33)个月.术后超声骨刀组出现1例喉返神经损伤,枪钳减压组出现2例脑脊液漏、2例喉返神经损伤,两组均未导致严重并发症.超声骨刀组的手术时间、术中失血量、术后引流量较枪钳减压组少(P＜0.05);但两组的住院时长相当,差异无统计学意义(P＞0.05).两组末次随访时NDI指数较术前明显降低(P＜0.05),JOA评分较术前显著增高(P＜0.05);超声骨刀组的JOA评分、JOA改善率优于枪钳减压组,两组比较差异有统计学意义(P＜0.05);但两组的末次随访时NDI指数比较,差异无统计学意义(P＞0.05).两组术后椎管占位率较术前明显降低(P＜0.05),颈椎Cobb角较术前明显增加(P＜0.05);超声骨刀组末次随访时颈椎Cobb角优于枪钳减压组(P＜0.05);但末次随访时两组椎管占位率、融合率比较,差异无统计学意义(P＞0.05).结论 显微镜下超声骨刀在颈椎前路减压术可以显著减少出血及缩短手术时间,改善功能恢复.
Objective To investigate the merits and demerits and clinical efficacy of ultrasonic bone knife under microscope in anterior cervical decompression compared with traditional lamina bone-biting forceps in anterior ossification of cervical spondylosis.Methods The 32 patients who underwent anterior cervical decompression and fusion in the Second Affiliated Hospital,Air Force Medical University from May 2017 to June 2019 were retrospectively analyzed.There were 18 cases in the ultrasonic bone knife group and 14 cases in the lamina bone-biting forceps decompression group.The operation time,bleeding volume,postoperative drainage volume,hospitalization days,complications,JOA score and NDI score,imaging spinal canal occupancy rate,cervical Cobb angle and fusion rate were recorded and compared between the two groups.Results Two groups of patients were successfully completed surgery,the patients in the two groups were followed up for 12-24 months,with an average of(16.18±3.33)months.One case of recurrent laryngeal nerve injury occurred in the ultrasonic bone knife group after operation,there were 2 cases of cerebrospinal fluid leakage and 2 cases of recurrent laryngeal nerve injury in the lamina bone-biting forceps decompression group,no serious complications occurred in both groups.The operation time,intraoperative blood loss and postoperative drainage volume of the ultrasonic bone knife group were less than those of the lamina bone-biting forceps decompression group(P<0.05).At the last follow-up,the NDI index of the two groups was significantly lower than that before operation(P<0.05),and the JOA score was significantly higher than that before operation(P<0.05).There was no significant difference in NDI index between the two groups at the last follow-up(P>0.05).The JOA score and the JOA improvement rate of the ultrasonic bone knife group was better than that of the lamina bone-biting forceps decompression group,and the difference was statistically significant(P<0.05).The postoperative spinal canal occupation rate of the two groups was significantly lower than that before operation(P<0.05),and the cervical Cobb angle were significantly increased before operation(P<0.05).There was no significant difference in spinal canal occupation rate between the two groups at the last follow-up(P>0.05).The cervical Cobb angle of the ultrasonic bone knife group were better than those of the lamina bone-biting forceps decompression group(P<0.05).Conclusion Microsurgical anterior cervical decompression with ultrasonic bone knife can significantly reduce bleeding,shorten operation time,reduce complications and improve functional recovery.
Objective To investigate the merits and demerits and clinical efficacy of ultrasonic bone knife under microscope in anterior cervical decompression compared with traditional lamina bone-biting forceps in anterior ossification of cervical spondylosis.Methods The 32 patients who underwent anterior cervical decompression and fusion in the Second Affiliated Hospital,Air Force Medical University from May 2017 to June 2019 were retrospectively analyzed.There were 18 cases in the ultrasonic bone knife group and 14 cases in the lamina bone-biting forceps decompression group.The operation time,bleeding volume,postoperative drainage volume,hospitalization days,complications,JOA score and NDI score,imaging spinal canal occupancy rate,cervical Cobb angle and fusion rate were recorded and compared between the two groups.Results Two groups of patients were successfully completed surgery,the patients in the two groups were followed up for 12-24 months,with an average of(16.18±3.33)months.One case of recurrent laryngeal nerve injury occurred in the ultrasonic bone knife group after operation,there were 2 cases of cerebrospinal fluid leakage and 2 cases of recurrent laryngeal nerve injury in the lamina bone-biting forceps decompression group,no serious complications occurred in both groups.The operation time,intraoperative blood loss and postoperative drainage volume of the ultrasonic bone knife group were less than those of the lamina bone-biting forceps decompression group(P<0.05).At the last follow-up,the NDI index of the two groups was significantly lower than that before operation(P<0.05),and the JOA score was significantly higher than that before operation(P<0.05).There was no significant difference in NDI index between the two groups at the last follow-up(P>0.05).The JOA score and the JOA improvement rate of the ultrasonic bone knife group was better than that of the lamina bone-biting forceps decompression group,and the difference was statistically significant(P<0.05).The postoperative spinal canal occupation rate of the two groups was significantly lower than that before operation(P<0.05),and the cervical Cobb angle were significantly increased before operation(P<0.05).There was no significant difference in spinal canal occupation rate between the two groups at the last follow-up(P>0.05).The cervical Cobb angle of the ultrasonic bone knife group were better than those of the lamina bone-biting forceps decompression group(P<0.05).Conclusion Microsurgical anterior cervical decompression with ultrasonic bone knife can significantly reduce bleeding,shorten operation time,reduce complications and improve functional recovery.