【摘要】：目的探討超聲骨刀應(yīng)用于頸椎后路單開(kāi)門椎管擴(kuò)大成形術(shù)的安全性及療效。方法回顧分析2012年1月—2016年1月,收治的符合選擇標(biāo)準(zhǔn)的193例行頸椎后路單開(kāi)門椎管擴(kuò)大成形術(shù)(C3~7)患者臨床資料。根據(jù)術(shù)中使用器械不同分為3組:應(yīng)用超聲骨刀61例(A組),應(yīng)用三關(guān)節(jié)咬骨鉗及椎板咬骨鉗73例(B組),應(yīng)用微型磨鉆59例(C組)。3組患者性別、年齡、病程、合并基礎(chǔ)疾病及術(shù)前日本骨科協(xié)會(huì)(JOA)評(píng)分、疼痛視覺(jué)模擬評(píng)分(VAS)比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。記錄并比較3組手術(shù)時(shí)間、術(shù)中出血量、術(shù)后48 h引流量、JOA評(píng)分及改善率、VAS評(píng)分以及圍術(shù)期并發(fā)癥發(fā)生情況。結(jié)果 A組手術(shù)時(shí)間、術(shù)中出血量及術(shù)后48 h引流量均顯著少于B、C組(P0.05),B、C組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3組患者均獲隨訪,A組隨訪時(shí)間12~21個(gè)月,平均14.6個(gè)月;B組24~36個(gè)月,平均27.5個(gè)月;C組28~47個(gè)月,平均38.1個(gè)月。3組術(shù)后均未發(fā)生腦脊液漏、切口感染,隨訪期間無(wú)內(nèi)固定物松動(dòng)、脫出、斷裂等并發(fā)癥發(fā)生。A組6例、B組8例、C組6例出現(xiàn)肩部放射痛,給予脫水劑、物理治療等處理,1周后疼痛均消失。3組均未出現(xiàn)C5神經(jīng)根麻痹。A、C組均未出現(xiàn)門軸斷裂;B組5例7個(gè)門軸發(fā)生斷裂,予以微型鈦板固定。末次隨訪時(shí),3組JOA評(píng)分及VAS評(píng)分均較術(shù)前顯著改善(P0.05);3組間JOA評(píng)分及改善率以及VAS評(píng)分比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論采用超聲骨刀行頸椎單開(kāi)門椎管擴(kuò)大成形術(shù)安全可靠、手術(shù)時(shí)間短,臨床療效與傳統(tǒng)手術(shù)操作相似,可避免椎板門軸側(cè)斷裂。
[Abstract]:Objective to evaluate the safety and efficacy of ultrasonic bone knife in posterior cervical open door laminoplasty. Methods from January 2012 to January 2016, 193 patients with posterior open door laminoplasty (C3F7) were retrospectively analyzed. According to the different instruments used during operation, the patients were divided into three groups: 61 cases were treated with ultrasonic bone knife (group A), 73 cases were treated with triarticular rongeur and laminar forceps (group B), 59 cases were treated with micro-grinding drill (group C). There was no significant difference in (JOA) score and pain visual analogue score (VAS) between basic diseases and preoperative Japanese orthopedic Association (P0.05). The operative time, intraoperative bleeding volume, JOA score, improvement rate and VAS score and perioperative complications were recorded and compared among the three groups. Results the time of operation, the amount of blood loss during operation and the drainage flow at 48 hours after operation in group A were significantly less than those in group B (P0.05). There was no significant difference between group C and group C (P0.05). The follow-up time of group A was 12 ~ 21 months (mean 14.6 months), and that of group B was 24 ~ 36 months. There was no cerebrospinal fluid leakage, incision infection, and no internal fixation loosening, extubation, rupture and other complications occurred in group A (n = 6), group B (n = 8) and group C (n = 6). After 1 week of treatment with dehydrating agent and physical therapy, the pain disappeared in all the groups. No C5 nerve root palsy was found in group 3. In group A, there was no rupture of portal axis in group B, and in group B, there was no rupture of portal axis in 5 cases and 7 cases in group B were fixed with micro titanium plate. At the last follow-up, the JOA scores and VAS scores of the three groups were significantly improved compared with the preoperative ones (P0.05). There was no significant difference in the JOA score and the improvement rate and the VAS score between the three groups (P0.05). Conclusion it is safe and reliable to use ultrasonic bone knife to open the open cervical vertebra canal expansion surgery, the operation time is short, the clinical curative effect is similar to the traditional operation, can avoid the lamina portalis axial fracture.
【作者單位】： 漯河醫(yī)學(xué)高等專科學(xué)校第一附屬醫(yī)院脊柱科;
【分類號(hào)】：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(xué);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(xué);2014年

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本文編號(hào)：2256049