应用超声骨刀行腰椎后路椎板切除术与传统手术技术的对比研究

Comparative study between ultrasonic bone curette and traditional surgical techniques for posterior lumbar laminectomy

中文关键词:  超声骨刀  椎板切除术  腰椎管狭窄症

英文关键词:Ultrasonic bone curette  Laminectomy  Lumbar spinal stenosis

中文摘要:

  【摘要】 目的：探讨应用超声骨刀行腰椎后路椎板切除术的效果及安全性。方法：总结分析2015年2月～2016年11月由北京大学国际医院完成的腰椎手术病例共计85例，A组为采用超声骨刀行腰椎后路椎板切除的62例患者，其中28例由具备2年脊柱外科手术经验的医师c完成（Ac组），34例由具备25年脊柱外科手术经验的医师d完成（Ad组）；B组为采用传统操作器械行腰椎后路椎板切除术的23例患者，其中10例由医师c完成（Bc组），13例由医师d完成（Bd组）。所有病例术前诊断均为腰椎管狭窄症，手术切除腰椎椎板共计119节段，手术方式均采用后路腰椎体间融合术（posterior lumbar interbody fusion，PLIF），实时记录术中椎板切除时间，手术出血量，统计术中硬膜损伤及神经根损伤等并发症发生情况，手术前1d及术后1周行ODI评分评估患者症状缓解情况。结果：Ａ组椎板切除平均耗时分别为3.24±0.80min（Ac组）和3.48±0.82min（Ad组）；Ｂ组椎板切除平均耗时分别为18.84±4.21min（Bc组）和3.72±1.03min（Bd组），Bc组手术耗时较其他组显著延长（P<0.05）。术中出血量、各组手术前后ODI及VAS改善情况无显著统计学差异（P>0.05）。A组硬膜损伤2例，B组1例，Ad组神经根损伤1例。结论：采用超声骨刀行腰椎后路椎板切除术具备可行性，应用超声骨刀并没有增加硬膜损伤及神经根损伤的发生率，相对于应用骨刀及椎板咬骨钳等普通器械切除腰椎椎板，超声骨刀技术更加容易掌握，学习曲线更短。

英文摘要:

  【Abstract】 Objectives: To study the effectiveness and safety of ultrasonic bone curette in lumbar laminectomy. Methods: 85 cases with lumbar canal stenosis underwent lumbar surgery in Peking University International Hospital between February 2015 and November 2016, 62 cases were performed with posterior lumbar interbody fusion(PLEF) surgery, in which 28 cases were performed by doctor c with 2-year experience in spinal surgery(group Ac), 34 cases were performed by doctor d with 25-year experience in spinal surgery(group Ad); the other 23 cases were performed with traditional instrument, in which 10 cases were performed by doctor c(group Bc), 13 cases were performed by doctor d(group Bd). All cases were diagnosed of lumbar canal stenosis, a total of 119 segments were performed, real-time laminectomy, blood loss, cases of epidural injury and nerve root injury, ODI score at 1 day preoperation and 1 week postoperation were recorded among groups. Results: The average time of laminectomy with ultrasonic curette was 3.24±0.80min(group Ac), 18.84±4.21min(group Bc), and the average operation time with traditional instrument was 3.48±0.82min(group Ad), 3.72±1.03min(group Bd). As for intraoperative blood loss, there were no significant differences of the blood loss, the ODI and VAS improvement among groups. A total of 3 cases suffered from epidural injury in this study, 2 in group A and 1 in group B， only 1 of which was related with ultrasonic curette, 1 case suffered from nerve root injury. Conclusions: Lumbar laminectomy can be safely and effectively performed by ultrasonic bone curette, which will not increase the risks of epidural injury and nerve root injury, and compared with the traditional technique, ultrasonic bone curette is easier to learn.