本文選題：超聲骨刀 + 椎板切除術(shù)��； 參考：《中國脊柱脊髓雜志》2017年08期

【摘要】：目的 :探討應(yīng)用超聲骨刀行腰椎后路椎板切除術(shù)的效果及安全性。方法 :總結(jié)分析2015年2月~2016年11月由北京大學國際醫(yī)院完成的腰椎手術(shù)病例共計85例,A組為采用超聲骨刀行腰椎后路椎板切除的62例患者,其中28例由具備2年脊柱外科手術(shù)經(jīng)驗的醫(yī)師c完成(Ac組),34例由具備25年脊柱外科手術(shù)經(jīng)驗的醫(yī)師d完成(Ad組);B組為采用傳統(tǒng)操作器械行腰椎后路椎板切除術(shù)的23例患者,其中10例由醫(yī)師c完成(Bc組),13例由醫(yī)師d完成(Bd組)。所有病例術(shù)前診斷均為腰椎管狹窄癥,手術(shù)切除腰椎椎板共計119節(jié)段,手術(shù)方式均采用后路腰椎體間融合術(shù)(posterior lumbar interbody fusion,PLIF),實時記錄術(shù)中椎板切除時間,手術(shù)出血量,統(tǒng)計術(shù)中硬膜損傷及神經(jīng)根損傷等并發(fā)癥發(fā)生情況,手術(shù)前1d及術(shù)后1周行ODI評分評估患者癥狀緩解情況。結(jié)果:A組椎板切除平均耗時分別為3.24±0.80min(Ac組)和3.48±0.82min(Ad組);B組椎板切除平均耗時分別為18.84±4.21min(Bc組)和3.72±1.03min(Bd組),Bc組手術(shù)耗時較其他組顯著延長(P0.05)。術(shù)中出血量、各組手術(shù)前后ODI及VAS改善情況無顯著統(tǒng)計學差異(P0.05)。A組硬膜損傷2例,B組1例,Ad組神經(jīng)根損傷1例。結(jié)論:采用超聲骨刀行腰椎后路椎板切除術(shù)具備可行性,應(yīng)用超聲骨刀并沒有增加硬膜損傷及神經(jīng)根損傷的發(fā)生率,相對于應(yīng)用骨刀及椎板咬骨鉗等普通器械切除腰椎椎板,超聲骨刀技術(shù)更加容易掌握,學習曲線更短。
[Abstract]:Objective: to evaluate the effect and safety of posterior lumbar laminectomy with ultrasonic bone knife. Methods: from February 2015 to November 2016, a total of 85 cases of lumbar vertebrae surgery were performed by Peking University International Hospital. Group A received posterior lumbar laminectomy with ultrasonic bone knife. Among them, 28 cases were completed by a physician with 2 years' experience in spinal surgery c and 34 cases in group A (with 25 years of experience in spinal surgery). Group B was treated as 23 patients undergoing posterior lumbar laminectomy with traditional instruments. Among them, 10 cases were completed by doctor c and 13 cases by doctor d. All the patients were diagnosed as lumbar spinal stenosis before operation. The total number of lumbar laminectomy was 119segments. The posterior lumbar interbody fusion was used in all cases. The time of laminectomy and the amount of blood lost during the operation were recorded in real time. The complications such as dural injury and nerve root injury during operation were analyzed. The symptom relief was evaluated by ODI score 1 day before operation and 1 week after operation. Results the average time of laminectomy in group 1: a was 3.24 鹵0.80min(Ac) and that in group B was 18.84 鹵4.21min(Bc in group C (3.48 鹵0.82min(Ad). The time of laminectomy in group B (3.72 鹵1.03min(Bd) was significantly longer than that in group B (3.72 鹵1.03min(Bd). There was no significant difference in the amount of intraoperative bleeding and the improvement of ODI and VAS before and after operation. In group A, there were 2 cases of dural injury and 1 case of nerve root injury in group B (1 case). Conclusion: it is feasible to use ultrasonic bone knife for posterior lumbar vertebra laminectomy. Ultrasonic bone knife does not increase the incidence of dural injury and nerve root injury, compared with common instruments such as bone knife and laminectomy forceps. Ultrasonic bone knife technology is easier to master, learning curve is shorter.
【作者單位】： 北京大學國際醫(yī)院骨科;
【分類號】：R687.3

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1 劉昊;新型超聲骨刀應(yīng)用于椎間孔成形術(shù)的研究[D];蘇州大學;2016年

2 鄭家春;超聲骨刀技術(shù)在頸椎胸椎手術(shù)中的應(yīng)用[D];山東大學;2014年

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