超声骨刀在胸椎管狭窄症手术中应用的有效性与安全性

Safety and reliability of ultrasonic bone curette on the spinal decompression procedure in patients with thoracic spinal stenosis

中文关键词:  椎管狭窄症  胸椎  手术  超声骨刀

英文关键词:Spinal stenosis  Thoracic spine  Operation  Ultrasonic bone curette

中文摘要:

  【摘要】 目的：探讨超声骨刀在胸椎管狭窄症手术中应用的有效性与安全性。方法：2014年12月~2015年5月确诊为胸椎管狭窄症并应用超声骨刀进行后路胸脊髓减压术的患者28例，其中单纯行胸椎管后壁切除术者16例，共计切除胸椎管后壁55个节段；在胸椎管后壁切除基础上再行单节段环形减压术者12例，共计切除胸椎管后壁44个节段。术中实时记录胸椎管后壁切除时间、术中出血量、术中有无神经根损伤和脊髓损伤、有无硬膜损伤和脑脊液漏；术后第5天评估患者症状改善情况。结果：28例患者单个节段胸椎管后壁切除的时间为3.0±1.4min（2.0~5.7min）。单纯行胸椎管后壁切除术的16例患者单个节段胸椎管后壁切除的术中出血量为108.3±47.3ml（50.0~200.0ml）；行环形减压术的12例患者术中出血量为513.8±217.0ml（255.0~800.0ml）。未出现因为超声骨刀切割导致的硬膜损伤、脑脊液漏；在进行“揭盖式”胸椎管后壁切除术中，2例患者分别发生左侧T2、T4神经根切割，均发生在黄韧带骨化导致椎管严重狭窄的节段，其中1例患者术后出现左侧胸壁放射痛，保守治疗4周后好转；另1例术后无明显不适。术后第5天28例患者的症状均有不同程度的改善，无脊髓损害症状加重的患者。结论：应用超声骨刀可以相对安全、有效地完成胸椎管狭窄症的减压手术；在黄韧带骨化导致胸椎管严重狭窄的节段，应用超声骨刀进行“揭盖式”胸椎管后壁切除时有损伤相应节段神经根的风险，应严格控制切割深度。

英文摘要:

  【Abstract】 Objectives: To evaluate the safety and reliability of ultrasonic bone curette on spinal decompression procedure in patients with thoracic spinal stenosis. Methods: Twenty-eight patients who underwent posterior decompression surgery due to thoracic spinal canal sternosis by using ultrasonic bone curette between December 2014 and May 2015 were collected, posterior decompressive laminectomy was performed in 16 patients with 55 segments, and 12 patients with 44 segments underwent circumferential decompression further. Location of spinal decompression, operation time of decompressive laminectomy, blood loss as well as perioperative complications such as durotomy, cerebrospinal fluid leak, injury of nerve root and spinal cord were recorded. The improvements of clinical symptoms were analyzed on the 5th day after operation. All the indexes above mentioned were used to evaluate the outcome of the application of ultrasonic bone curette. Results: Among these twenty-eight patients, the average time for each segment was 3.0±1.4min (range, 2.0-5.7min). In the 16 patients performed by simple posterior decompressive laminectomy, the average blood loss for each segment was 108.3±47.3ml(range, 50.0-200.0ml). In the 12 patients who underwent circumferential decompression further, the blood loss was 513.8±217.0ml(range, 255.0-800.0ml). No patient suffered from intraoperative dural matter tearing and cerebrospinal fluid leakage due to the application of ultrasonic bone curette. Among the 28 patients(99 segments) treated by ultrasonic bone curette, 2 patients suffered from unilateral T2 and T4 nerve root injury during posterior laminectomy, and one patient experienced new-onset radiation pain in chest wall due to severe ossification of ligmentum flavum, which was cured by conservative treatment. While the other patient presented with no discomfort complaint. The syndromes of these 28 patients relieved in various degrees and no patients had neurological deficits postoperatively. Conclusions: The ultrasonic bone curette is safe and effective for thoracic spinal stenosis. When it is used in extremely stenosis segment, nerve root injury is not uncommon, which can be avoided by cautioning the cutting depth of the ultrasonic bone curette.