超声骨刀在脊髓型颈椎病全椎板切除术中的应用

Application of piezosurgery in cervical laminectomy for cervical spondylotic myelopathy

中文关键词:  脊髓型颈椎病  全椎板切除术  超声骨刀  磨钻

英文关键词:Cervical spondylotic myelopathy  Laminectomy  Piezosurgery  Drill

中文摘要:

  【摘要】 目的：对比研究超声骨刀与高速磨钻应用于脊髓型颈椎病全椎板切除术的有效性与安全性。方法：回顾性分析2014年1月~2015年12月我科收治的36例脊髓型颈椎病行全椎板切除术的患者临床资料，其中超声骨刀组16例（A组，男9例，女7例，年龄58.4±11.7岁）、高速磨钻组20例（B组，男11例，女9例，年龄61.6±12.4岁）。比较两组间手术节段、手术时间、术中出血量、术后引流量、术前及术后1周日本骨科学会（Japanese orthopedics association，JOA）评分、JOA评分改善率、围手术期并发症等指标。结果：两组间手术节段、术前JOA无统计学差异（P＞0.05），A组和B组术中出血量分别为141.7±76.5ml和196.5±93.2ml，无统计学差异（P＞0.05）；A组手术时间120.6±32.7min明显少于B组159.2±35.5min（P＜0.05）；术后引流量为164.5±84.2ml明显低于B组的236.2±93.4ml（P＜0.05）。两组患者术后JOA评分（A组14.6±1.1分，B组14.5±1.6分）均优于术前（A组10.1±1.4分，B组10.8±2.1分，P＜0.05），但两组间术前、术后JOA评分及JOA评分改善率[A组（75.1±12.3）% VS B组（70.4±16.2）%]比较，无统计学差异（P＞0.05）。两组各发生硬膜囊撕裂1例，均无持续脑脊液漏及伤口感染病例。结论：脊髓型颈椎病全椎板切除术中应用超声骨刀可缩短手术时间及减少术后引流量，其安全性和有效性与高速磨钻相似。

英文摘要:

  【Abstract】 Objectives: To compare the effectiveness and reliability between piezosurgery and high-speed drill osteotomy in cervical laminectomy for cervical spondylotic myelopathy. Methods: A total of 36 patients with cervical spondylotic myelopathy who underwent posterior laminectomy surgery from January 2014 to December 2015 was retrospectively analyzed in this study. Sixteen patients(group A, M:F=9:7, age=58.4±11.7 year-old) were treated with piezosurgery osteotomy, and 20 patients(group B, M:F=11:9, age=61.6±12.4 year-old) were treated with high-speed drill osteotomy. The surgical segments, duration of surgery, intraoperative hemorrhage, postoperative drainage, pre-operative and one-week post-operative JOA(Japanses orthopedic assoiation) score, the improvement rate of JOA and perioperative complication were compared between piezosurgery group and high-speed drill group. Results: Compared with high-speed drill osteotomy, the duration of surgery and postoperative drainage of piezosurgery osteotomy group were significantly less(duration of surgery: 120.6±32.7min vs. 159.2±35.5min, postoperative drainage: 164.5±84.2ml vs. 236.2±93.4ml, P＜0.05). No significant difference was found in intraoperative hemorrhage between the two groups(141.7±76.5ml vs. 196.5±93.2ml, P＞0.05). The JOA scores were significantly improved in both groups after surgery(group A: preoperative 10.1±1.4， postoperative 14.6±1.1; group B: preoperative 10.8±2.1, postoperative 14.5±1.6; P＜0.05), but no significant difference was found in the improvement rate of JOA score [group A, (75.1±12.3)% vs. group B, (70.4±16.2)%] between the two groups(P>0.05). One case in each group experienced incidental dural tear. None of the patients had sustained cerebrospinal fluid leakage or wound infection in the both groups. Conclusions: The duration of surgery and postoperative drainage are reduced with the use of piezosurgery in cervical laminectomy for cervical spondylotic myelopathy. The effectiveness and safety of piezosurgery osteotomy is similar to the high-speed drill osteotomy.