Li Yuwei, Wang Haijiao, Cui Wei, Li Cheng, Zhou Peng, Zhang Yonghui
Department of Spine Surgery, the First Affiliated Hospital of Luohe Medical College, Luohe Henan, 462000,
Department of Spine Surgery, the First Affiliated Hospital of Luohe Medical College, Luohe Henan, 462000, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Jun 15;31(6):683-689. doi: 10.7507/1002-1892.201702002.
To investigate the safety and reliability of ultrasonic bone curette in posterior cervical single open-door laminoplasty.
The clinical data were retrospectively analyzed, from 193 patients who underwent single open-door laminoplasty (C ) from January 2012 to January 2016. The patients were divided into three groups according to different instruments: posterior single open-door laminoplasty was performed with ultrasonic bone curette in 61 cases (group A), with bite forceps in 73 cases (group B), and with micro-grinding drill in 59 cases (group C). There was no significant difference in gender, age, the course of disease, underlying disease and preoperative Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS) between groups ( >0.05). The operative time, intraoperative blood loss, drainage volume at 48 hours, JOA score, improvement rate, VAS and perioperative com-plication were compared.
The operative time, intraoperative blood loss, and drainage volume at 48 hours of group A were significantly less than those in groups B and C ( <0.05), but there was no significant between groups B and C ( >0.05). The follow-up time was 12-21 months (mean, 14.6 months) in group A, 24-36 months (mean, 27.5 months) in group B, and 28-47 months (mean, 38.1 months) in group C. There were no cerebrospinal fluid leakage and incision infection in three groups. No complications of internal fixation loosening and rupture occurred during the follow-up. Rediating pain occurred in 6 cases of group A, 8 cases of group B, and 6 cases of group C, and was cured at 1 week after dehydration and physical therapy. No nerve root palsy was found in three groups. Fracture of portal axis occurred in 5 cases (7 segments) of group B and was fixed by micro titanium plate. The JOA score and VAS score at last follow-up were significantly improved when compared with preoperative scores in three groups ( <0.05); there was no significant difference in JOA score and improvement rate and VAS score between groups ( >0.05).
It is safe and reliable to use the ultrasonic bone curette in posterior cervical single open-door laminoplasty. It can shorten the operative time and has similar clinical curative effect to the traditional operation, and the lateral rotation of the lamina can be avoided.
探讨超声骨刀在颈椎后路单开门椎管扩大成形术中应用的安全性和可靠性。
回顾性分析2012年1月至2016年1月行单开门椎管扩大成形术（C）的193例患者的临床资料。根据不同手术器械将患者分为三组：61例行超声骨刀辅助颈椎后路单开门椎管扩大成形术（A组），73例行咬骨钳辅助颈椎后路单开门椎管扩大成形术（B组），59例行微型磨钻辅助颈椎后路单开门椎管扩大成形术（C组）。三组患者在性别、年龄、病程、基础疾病及术前日本骨科学会（JOA）评分、视觉模拟评分法（VAS）等方面比较差异无统计学意义（>0.05）。比较三组患者手术时间、术中出血量、术后48小时引流量、JOA评分、改善率、VAS评分及围手术期并发症。
A组手术时间、术中出血量及术后48小时引流量均明显少于B组和C组（<0.05），但B组和C组比较差异无统计学意义（>0.05）。A组随访时间为1221个月（平均14.6个月），B组为2436个月（平均27.5个月），C组为28~47个月（平均38.1个月）。三组均无脑脊液漏及切口感染发生。随访期间均未出现内固定松动、断裂等并发症。A组6例、B组8例、C组6例出现放射性疼痛，经脱水及理疗1周后治愈。三组均未发现神经根麻痹。B组5例（7节段）出现门轴骨折，采用微型钛板固定。三组末次随访时JOA评分及VAS评分均较术前明显改善（<0.05）；三组间JOA评分、改善率及VAS评分比较差异无统计学意义（>0.05）。
超声骨刀应用于颈椎后路单开门椎管扩大成形术安全可靠，可缩短手术时间，临床疗效与传统手术相似，且可避免椎板侧方旋转。
