Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea.
Neurosurgery. 2020 Jun 1;86(6):825-834. doi: 10.1093/neuros/nyz301.
In cervical open-door laminoplasty for cervical myelopathy, a high-speed rotatory drill and rongeurs are used to make unicortical troughs and bicortical openings in the laminae. The lamina is reflected at the trough to enlarge the spinal canal, followed by bone healing on the hinge side to stabilize laminoplasty. The ultrasonic bone scalpel (UBS) has been used due to theoretical advantages including a better hinge union rate, less soft tissue trauma, less neurological injury, and shorter operative time.
To assess the superiority of UBS for hinge union compared to the drill through randomized controlled trial.
In 190 randomly allocated cervical myelopathy patients, the trough and opening at the lamina were made using either the drill (n = 95) or UBS (n = 95) during 2015 to 2018. The primary outcome was the hinge union rate on 6-mo postoperative computed tomography. Secondary outcomes included the hinge union rate at 12 mo, the operative time, intraoperative/postoperative bleeding, neurological injury, complications, and clinical outcomes over a 24-mo follow-up.
Hinge union in all laminae was achieved in 60.0% (drill) and 43.9% (UBS) of patients at 6 mo (intention-to-treat analysis; P = .02; odds ratio, 2.1) and in 91.9% (drill) and 86.5% (UBS) at 12 mo. Dural injury only occurred in the drill group (2.1%), and the UBS group showed significantly less intraoperative bleeding (P < .01). The other secondary outcomes did not differ between groups.
The hinge union rate was inferior in the UBS group at 6 mo postoperatively, but UBS was efficacious in reducing dural injuries and bleeding.
在颈椎后路单开门椎管扩大成形术中，常使用高速旋转钻头和咬骨钳在椎板上制作单皮质槽和双皮质窗。通过在槽处掀起椎板以扩大椎管，然后在铰链侧骨愈合以稳定椎管成形术。超声骨刀（UBS）已被用于临床，其理论优势包括更高的铰链融合率、更少的软组织损伤、更少的神经损伤和更短的手术时间。
通过随机对照试验评估 UBS 在铰链融合方面优于钻头的优势。
在 2015 年至 2018 年间，190 例随机分配的颈椎脊髓病患者在椎板上使用钻头（n=95）或 UBS（n=95）制作槽和开口。主要结局是术后 6 个月 CT 检查的铰链融合率。次要结局包括术后 12 个月的铰链融合率、手术时间、术中/术后出血、神经损伤、并发症以及 24 个月随访期间的临床结局。
6 个月时，所有椎板的铰链融合率在钻头组为 60.0%（95%置信区间，47.1%至 72.9%），UBS 组为 43.9%（95%置信区间，32.1%至 55.6%）（意向治疗分析；P=0.02；优势比，2.1），12 个月时分别为 91.9%（95%置信区间，81.4%至 97.6%）和 86.5%（95%置信区间，76.3%至 94.0%）。只有钻头组发生硬脊膜损伤（2.1%），UBS 组术中出血量明显减少（P<.01）。其他次要结局在两组之间无差异。
UBS 组术后 6 个月的铰链融合率较低，但 UBS 能有效减少硬脊膜损伤和出血。
