發(fā)布時間：2018-05-14 17:22

  本文選題：超聲骨刀 + 椎管內(nèi)腫瘤　； 參考：《吉林大學》2017年碩士論文

【摘要】：目的:研究在32例椎管內(nèi)腫瘤切除術(shù)中應(yīng)用超聲骨刀與傳統(tǒng)咬骨鉗的效果比較,觀察術(shù)后骨性愈合及神經(jīng)功能恢復(fù)情況,并分析超聲骨刀在安全性及可靠性方面的影響因素。方法:回顧性分析2015年9月至2016年9月于吉林大學第一醫(yī)院神經(jīng)腫瘤外科住院的患者中行椎管內(nèi)腫瘤切除手術(shù)的患者共32例,分為超聲骨刀組(16例)、咬骨鉗組(16例),入組患者均按美國脊柱損傷協(xié)會(ASIA)分級標準在術(shù)前評估脊神經(jīng)的功能情況。所有患者均由本醫(yī)療組帶組教授及副教授級神經(jīng)外科醫(yī)師實施手術(shù),超聲骨刀組術(shù)中采用超聲骨刀行椎板后路切開,處理完椎管內(nèi)腫瘤后再將卸下的棘突椎板復(fù)合體以鈦板、鈦釘固定,完成原位回植、實現(xiàn)椎管成形。咬骨鉗組術(shù)中采用咬骨鉗行傳統(tǒng)棘突椎板咬除術(shù)式,暴露手術(shù)部位硬脊膜,處理完椎管內(nèi)腫瘤后無椎管成形操作。記錄全部患者的一般資料及臨床表現(xiàn),分別統(tǒng)計兩組患者硬脊膜充分暴露所需時間、硬脊膜暴露過程手術(shù)出血量、術(shù)中硬脊膜損傷情況、術(shù)前術(shù)后3~6個月脊髓神經(jīng)功能恢復(fù)情況(ASIA分級)及骨質(zhì)愈合情況(超聲骨刀組)。對研究結(jié)果采用SPSS 18.0進行統(tǒng)計學分析,比較兩組患者術(shù)中情況、出院后骨愈合及功能恢復(fù)情況。結(jié)果:本研究共順利實施椎管內(nèi)腫瘤切除術(shù)32例,超聲骨刀組在術(shù)中及術(shù)后骨愈合方面表現(xiàn)出較明顯優(yōu)勢,其術(shù)中完全暴露硬脊膜過程中出血量少于咬骨鉗組(P0.05),未增加硬脊膜損傷率,遠期神經(jīng)功能得到良好恢復(fù)(ASIA分級)。另外,雖然總樣本中暴露硬脊膜的手術(shù)時間二者差異無統(tǒng)計學意義(P0.05),但是當切除脊椎節(jié)段≥5時,超聲骨刀組能夠比咬骨鉗組更明顯地縮短手術(shù)時間、減少出血量。術(shù)中超聲骨刀體現(xiàn)出切割精度高、操作效率高、手部疲勞性低、手術(shù)出血少、術(shù)野清晰、對軟組織保護好等優(yōu)勢,特別適用于多節(jié)段椎管內(nèi)腫瘤手術(shù)的椎板切除。術(shù)后3~6個月超聲骨刀組部分患者回植的棘突椎板復(fù)合體出現(xiàn)骨性愈合,1例發(fā)生輕度醫(yī)源性椎管狹窄,但患者無明顯神經(jīng)卡壓癥狀。結(jié)論:超聲骨刀作為一種新型手術(shù)器械,能夠安全有效地切除棘突椎板復(fù)合體,能縮短手術(shù)時間、減少出血量,其組織選擇性、熱效應(yīng)和空化效應(yīng)能夠在手術(shù)過程中很好的保護神經(jīng)血管等軟組織,并且超聲骨刀可以更方便地實現(xiàn)棘突椎板復(fù)合體的原位回植,對術(shù)后重建脊柱解剖結(jié)構(gòu)及后期脊柱穩(wěn)定性的維持具有重要臨床意義。故應(yīng)用超聲骨刀聯(lián)合棘突椎板回植術(shù)可在椎管內(nèi)腫瘤手術(shù)中推廣。
[Abstract]:Objective: to compare the effect of ultrasonic bone knife and traditional bone biting forceps in 32 cases of intraspinal tumor resection, to observe the recovery of bone healing and nerve function after operation, and to analyze the influencing factors of safety and reliability of ultrasonic bone knife. Methods: from September 2015 to September 2016, 32 patients who underwent intraspinal tumor resection in the Department of Neurooncology, first Hospital of Jilin University, were retrospectively analyzed. The patients were divided into ultrasonic scalpel group (n = 16) and bone-biting forceps group (n = 16). All the patients in the group were assessed the function of spinal nerve before operation according to the ASIA classification standard of American Spinal injury Association. All the patients were operated by professor and associate professor in our medical group. In the ultrasonic bone knife group, the posterior laminectomy was performed with ultrasonic bone knife, and the spinous process laminar complex was removed with titanium plate after the treatment of the tumor in the spinal canal. Titanium nail fixation, complete in situ replantation, to achieve spinal canal formation. In the bone biting forceps group, the traditional spinous process laminectomy was performed with bone biting forceps, which exposed the dura mater of the operation site, and had no spinal canal formation operation after the treatment of the tumors in the spinal canal. The general data and clinical manifestations of all the patients were recorded. The time required for full dural exposure, the amount of operative bleeding during dural exposure, and the intraoperative dural injury were counted. The recovery of spinal cord nerve function before and after 3 ~ 6 months after operation was assessed by Asia grade and bone healing (ultrasonic bone knife group). The results of the study were analyzed by SPSS 18.0. The intraoperative conditions, bone healing and functional recovery were compared between the two groups. Results: 32 cases of intraspinal tumor resection were performed successfully in this study. The ultrasonic bone knife group showed obvious advantages in bone healing during and after operation. The amount of blood lost during the operation was less than that in the bone-biting forceps group (P 0.05), but the rate of dural injury was not increased, and the long term nerve function was well recovered by Asia classification. In addition, although there was no significant difference between the two groups in the operation time of dural exposure in the total sample, when the spinal segment was 鈮，

本文編號：1888800