超声骨刀与高速磨钻在颈椎后路全椎板切除减压手术应用中的比较研究

Comparison of ultrasonic bone curette and high-speed drill on the posterior laminectomy procedure in patients with cervical ossification of posterior longitudinal ligament

中文关键词:  后纵韧带骨化  超声骨刀  高速磨钻  椎管狭窄  椎管减压

英文关键词:Ossification of posterior longitudinal ligament  Ultrasonic bone curette  Hight-speed drill  Spinal stenosis  Spinal decompression

中文摘要:

  【摘要】 目的：比较超声骨刀和高速磨钻在颈椎后纵韧带骨化症伴椎管狭窄行后路全椎板切除减压手术中的安全性与有效性。方法：回顾分析2013年9月～2016年12月确诊为颈椎后纵韧带骨化伴椎管狭窄症行颈椎后路全椎板切除减压结合侧块/椎弓根螺钉内固定的患者53例。其中超声骨刀组（A组）24例，共切除椎板101个节段。高速磨钻组（B组）29例，共切除椎板124个节段。观察记录两组患者术中全椎板切除时间、手术过程中单节段椎板切除平均出血量、围手术期并发症（脊髓损伤、神经根损伤、硬膜囊损伤、脑脊液漏等），JOA评分及改善率。术后评估两组患者神经症状及并发症情况。结果：两组患者的年龄、性别比、术前JOA评分和减压节段数差异均无统计学意义（P＞0.05）。A组患者平均单个节段全椎板截骨时间为1.7±1.1min（1.4～3.3min），低于B组的2.9±1.8min（1.9～5.6min）（P＜0.05），手术过程中两组单节段椎板切除平均出血量为52.4±36.5ml（35.1~285.6ml）和60.3±34.2ml（41.1~281.4ml），两组比较无显著性差异（P＞0.05）。A、B组JOA评分分别由术前9.3±3.1分提高到术后12.7±2.0分和术前9.1±3.4分提高到术后12.9±2.8分，P＜0.05。两组患者术后JOA评分均明显优于术前（P＜0.05），但两组JOA改善率（分别为45.6%和51.2%）比较，差异无统计学意义（P＞0.05）。两组患者均未出现脊髓、神经根及硬膜囊损伤，无截骨操作相关并发症发生。结论：超声骨刀和高速磨钻均能安全有效地完成颈椎OPLL后路全椎板切除减压手术，在减轻术者工作强度、不增加出血及并发症的同时，超声骨刀能有效缩短全椎板切除时间。

英文摘要:

  【Abstract】 Objectives: To compare the safety and effectiveness of ultrasonic bone eurette versus high-speed drill on spinal decompression in patients with cervical ossification of posterior longitudinal ligament(OPLL). Methods: From September 2013 to December 2016, fifty-three patients who underwent posterior laminectomy decompression surgery due to cervical OPLL by either ultrasonic bone curette(group A) or high-speed drill(group B) were collected. Posterior laminectomy was performed in 24 cervical OPLL patients with 101 segments in group A, and 29 patients with 124 segments in group B. 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, Japanese Orthopaedic Association(JOA) scores and the rate of improved JOA score were recorded. Results: There was no statistical difference in age, sex ratio, preoperative JOA scores and decompressive laminectomy between the two groups(P>0.05). The average time for each segment was 1.7+1.1min(range, 1.4-3.3min) in group A, it was significantly less than that in group B[2.9±1.8min(1.9-5.6min)](P<0.05). The average blood loss for each segment was 52.4±36.5ml(35.1-285.6ml) in group A and 60.3±34.2ml（41.1-281.4ml） in group B respectively, showing no significant difference between two groups(P>0.05). The postoperative neurological function of both groups improved compared with the preoperative one(P<0.05), but there were no statistical differences of postoperative JOA scores, JOA scoring improvement rate between two groups(P>0.05). No patient suffered from injury of nerve root and spinal cord or dural matter tearing during operation and no patients had neurological deficits postoperatively. Conclusions: Compared with high-speed drill, usage of ultrasonic bone curette is more efficient but similarly safe to perform posterior laminectomy for cervical OPLL patients.