超声骨刀与传统工具在退变性腰椎侧凸减压截骨术中的应用比较

Comparison between ultrasonic bone curette and traditional tools in degenerative lumbar scoliosis decompression and osteotomy

中文关键词:  超声骨刀  退变性腰椎侧凸  出血量  手术时间  安全性

英文关键词:Ultrasonic bone curette  Degenerative lumbar scoliosis  Blood loss  Operation time  Safety

中文摘要:

  【摘要】 目的：评价退变性腰椎侧凸（degenerative lumbar scoliosis，DLS）减压截骨术中应用超声骨刀的安全性和有效性。方法：选择2008年2月~2016年12月在我院行后路减压、Ponte截骨、长节段（≥5个椎体）固定融合术且年龄不小于45岁的54例DLS患者，根据减压截骨操作主力工具的不同分为超声骨刀组（28例）和传统工具组（26例）。比较两组患者器械并发症例数、出院时神经功能恶化例数、手术时间、估算出血量、单个融合椎体出血量和自体血回收量等指标。结果：虽然超声骨刀组减压椎板数、Ponte截骨数和切除间盘数显著多于传统工具组（P<0.05），但是两组的器械并发症例数和出院时神经功能恶化例数无统计学差异（P>0.05）。两组手术时间无统计学差异（P>0.05），且超声骨刀组估算出血量、单个融合椎体出血量和自体血回收量显著低于传统工具组（834.0±354.4ml vs 1467.3±804.9ml，P=0.002）（120.8±57.2ml vs 191.4±88.4ml，P=0.003）（342.3±179.9ml vs 552.2±295.2ml，P=0.003）。结论：应用超声骨刀完成DLS减压截骨手术安全、有效，超声骨刀能显著减少术中出血量，且在安全性方面至少不亚于传统工具。

英文摘要:

  【Abstract】 Objectives: To evaluate and compare the safety and effectiveness of ultrasonic bone curette(UBC) versus traditional tools(TT) in degenerative lumbar scoliosis(DLS) decompression and osteotomy. Methods: From February 2008 to December 2016, 54 DLS patients with age no younger than 45 years underwent posterior decompression. Ponte osteotomy, long segment(more than or equal to five levels) instrumented and fusion by UBC or TT were included as UBC group(28 patients) or TT group(26 patients) in our hospital. Instrumental complications, neurological deterioration at discharge, operation time, evaluated blood loss (EBL), EBL/vertebra fused and cell saver transfused were compared between the two groups. Results: The numbers of laminectomies, Ponte osteotomies and discectomies in UBC group were more than those of TT group(P<0.05). Instrument related complications and neurological function at discharge showed no significant difference between UBC group and TT group(P>0.05). The EBL, EBL/vertebra fused and cell saver transfused in UBC group were less than those in TT group(834.0±354.4ml vs 1467.3±804.9ml, P=0.002; 120.8±57.2ml vs 191.4±88.4ml, P=0.003; 342.3±179.9ml vs 552.2±295.2ml, P=0.003). Conclusions: The UBC is more effective and safe for posterior decompression, Ponte osteotomy, long segment instrumented and fusion in DLS patients. When compared to TT, the usage of UBC is relatively more effective with significant less intraoperative blood loss, and the safety of UBC is at least not less.