Liu J, Niu D Y, Bao X G, Jiang E Z, Shi J G, Chen D Y, Xu G H
Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):521-526. doi: 10.3760/cma.j.issn.0376-2491.2019.07.009.
To evaluate the safety and efficacy of the combined use of ultrasonic bone curette with the high-speed drill in posterior laminectomy and decompression procedure for severe thoracic spinal stenosis, and propose the optimal cutting position for ultrasonic bone curette during the laminectomy. By observing and measuring the parameters of thoracic pedicle, lamina, inner wall of the vertebral canal and their relation with the surrounding structures on cadavers, we provided a morphological marker for laminectomy by an ultrasonic bone curette. Data of 19 patients with severe thoracic spinal stenosis treated by posterior laminectomy and decompression were collected from June 2017 to June 2018 in Shanghai Changzheng Hospital. There were 11 males and 8 females, aged (50±6) years. The patients received laminectomy with the combined use of ultrasonic bone curette and the high-speed drill (Group A, 10) or the use of ultrasonic bone curette alone (Group B, 9). Operational time of decompressive laminectomy, blood loss, as well as perioperative complications such as durotomy, cerebrospinal fluid leak, injury of the nerve root and spinal cord were recorded in these two groups. The improvement of symptoms and the decompression width of the spinal canal were evaluated after operation. Two independent samples -test was used for the comparison of two sets of continuous normal distribution data. We had done the measurement in 6 cadavers. The mean distance between the boundary of cancellous-cortical bone of lamina and the inner wall of spinal canal was (0.9±0.4) mm, and the distance between the boundary of cancellous-cortical bone of pedicle and the inner wall of the spinal canal was (1.2±0.6) mm. For the surgeries in groups A, the mean laminectomy time for each segment was (4.4±0.5) min, the mean width of posterior laminectomy was (21.8±0.5) mm; and for the surgeries in group B, the mean laminectomy time for each segment was (5.0±0.5) min, the mean width of posterior laminectomy was (19.9±1.0) mm; there were significant differences in laminectomy time for each segment and the width of posterior laminectomy between the two groups (-2.391, 3.491, both 0.05). There was one case of dura injury and one case of thoracic nerve root injury during the operation in group B. It is safer and more reliable for the combined use of ultrasonic bone curette with the high-speed drill in posterior laminectomy and decompression procedure for the severe thoracic spinal stenosis. The interface between the cortical bone and the medial edge of cancellous bone of the pedicle could be identified as the cutting mark for ultrasonic bone curette in this procedure.
评估超声骨刮匙联合高速磨钻在严重胸段脊髓狭窄后路椎板切除术及减压手术中的安全性和有效性，并提出椎板切除术中超声骨刮匙的最佳切割位置。通过对尸体胸椎椎弓根、椎板、椎管内壁及其与周围结构关系的观察和测量，为超声骨刮匙椎板切除术提供形态学标志。收集2017年6月至2018年6月在上海长征医院接受后路椎板切除术及减压治疗的19例严重胸段脊髓狭窄患者的数据。其中男性11例，女性8例，年龄（50±6）岁。患者接受超声骨刮匙联合高速磨钻的椎板切除术（A组，10例）或单纯使用超声骨刮匙的椎板切除术（B组，9例）。记录两组减压性椎板切除术的手术时间、出血量以及围手术期并发症，如硬脊膜切开、脑脊液漏、神经根和脊髓损伤等。术后评估症状改善情况及椎管减压宽度。两组连续正态分布数据的比较采用两独立样本t检验。我们对6具尸体进行了测量。椎板松质骨-皮质骨边界与椎管内壁的平均距离为（0.9±0.4）mm，椎弓根松质骨-皮质骨边界与椎管内壁的距离为（1.2±0.6）mm。A组手术中，每节段平均椎板切除时间为（4.4±0.5）min，后路椎板切除平均宽度为（21.8±0.5）mm；B组手术中，每节段平均椎板切除时间为（5.0±0.5）min，后路椎板切除平均宽度为（19.9±1.0）mm；两组每节段椎板切除时间及后路椎板切除宽度比较差异有统计学意义（t=-2.391、3.491，P均＜0.05）。B组手术中有1例硬脊膜损伤和1例胸神经根损伤。超声骨刮匙联合高速磨钻用于严重胸段脊髓狭窄后路椎板切除术及减压手术更安全可靠。在此手术中，椎弓根皮质骨与松质骨内侧边缘的界面可作为超声骨刮匙的切割标志。
