超声骨刀在颈椎前路椎体次全切除术中应用的安全性和有效性评价

The efficacy and safety of ultrasonic bone cutter used in anterior cervical corpectomy and fusion surgery

中文关键词:  颈椎椎体次全切除  脊髓型颈椎病  超声骨刀

英文关键词:Anterior cervical corpectomy  Cervical spondylotic myelopathy  Ultrasonic bone cutter

中文摘要:

  【摘要】 目的：探讨超声骨刀在颈椎前路椎体次全切除手术中应用的安全性和有效性。方法：回顾性分析我院2015年4月~2017年3月确诊为脊髓型颈椎病行颈椎前路椎体次全切除手术的病例51例。根据术中切除椎体的工具分为两组。超声骨刀组（A组）应用超声骨刀切除椎体26例，男性15例，女性11例，年龄52.7±7.3岁（37~66岁）；传统工具组（B组）应用咬骨钳及高速磨钻切除椎体25例，其中男性13例，女性12例，年龄50.5±7.9 岁（38~67岁）。记录两组患者椎体切除时间、术中出血量、手术并发症、术前及术后3d的JOA评分及JOA评分改善率、住院时间等。结果：A组切除每节椎体的平均时间为8.3±1.5min，显著低于B组的11.3±1.5min（P<0.05）。手术出血量A组为122.6±28.0ml，显著低于B组的163.4±39.0ml（P<0.05）。两组患者均未出现术中脊髓损伤或硬膜撕裂，A组出现吞咽困难1例；B组出现喉上神经损伤1例、泌尿系感染1例。两组患者术前JOA评分分别为7.2±1.6分与6.8±1.4分，无统计学差异（P>0.05）。A组患者术后3d的JOA评分11.3±1.5分，B组患者术后3d的JOA评分10.9±1.3分，均显著高于术前（P<0.05）。患者JOA评分改善率两组分别为（41.7±13.6）%与（40.4±9.3）%，无统计学差异（P>0.05）。A、B两组患者住院时间分别为6.80±0.89d与6.84±1.06d，无统计学差异（P>0.05）。结论：在颈椎前路椎体次全切手术中应用超声骨刀安全有效，与传统的咬骨钳与高速磨钻相比，应用超声骨刀可以有效地缩短手术时间，减少手术出血量。

英文摘要:

  【Abstract】 Objectives: To investigate the efficacy and safety of osteotomy using ultrasonic bone cutter(UBC) in anterior cervical corpectomy and fusion surgery. Methods: A total of 51 cases diagnosed as cervical spondylotic myelopathy underwent anterior cervical corpectomy and fusion surgery from April 2015 to March 2017 in our hospital. They were divided into group A(UBC group) and group B(traditional tools group). In group A, there were 15 males and 11 females with an average age of 52.7±7.3（37-66） years old. There were 13 males and 12 females with an average age of 50.5±7.9（38-67） years old in group B. Osteotomy time, intraoperative blood loss, surgical complications such as spinal cord injury, dural tear as well as dysphagia, Japanese Orthopedic Association(JOA) score before and at 3 days after surgery, improvement rate of JOA score and hospitalization time were recorded. Results: The average osteotomy time was 8.3±1.5min in group A, which was significantly less than that in group B(11.3±1.5min, P<0.05). The average intraoperative blood loss was 122.6±28.0ml in group A, which was significantly less than that in group B(163.4±39.0ml, P<0.05). No spinal cord injury or dural tear was present in either group, and no patients had neurological deficits postoperatively. There was 1 case of dysphagia in group A, 1 case of laryngeal nerve injury and 1 case of urinary tract infection found in group B. The preoperative JOA score was 7.2±1.6 in group A and 6.8±1.4 in group B, which showed no significant difference between two groups(P>0.05). The postoperative JOA score was 11.3±1.5 and 10.9±1.3 in group A and B, respectively, which improved significantly compared with the preoperative one(P<0.05), but there were no significant differences in the improvement rate of JOA score, and hospitalization time(P>0.05). Conclusions: It is safe and effective to apply ultrasonic bone cutter in the anterior cervical corpectomy and fusion surgery. Compared with the traditional tools such as rongeur and high-speed grinding drill, the application of ultrasonic treatment can shorten the operation time and intraoperative blood loss effectively.