Li Y W, Wang H J, Cui W, Xiao W, Hu B T, Li F
Department of Orthopedics, Luohe Central Hospital, Luohe 462000, China.
Zhonghua Yi Xue Za Zhi. 2020 Mar 10;100(9):669-673. doi: 10.3760/cma.j.issn.0376-2491.2020.09.005.
To investigate the safety and efficiency of ultrasonic bone curette used in anterior cervical discectomy and fusion surgery. As a retrospective study, we collected and analyzed the clinical data of 47 patients receiving anterior cervical discectomy and fusion surgery in Luohe Central Hospital from January 2014 to January 2017, there were 26 males and 21 females with a mean age of (52±9) years. According to the different surgical tools used in the process of decompression by resecting osteophytes or bone like an inverted Chinese character "" located at the posterior margin of the vertebral body, the patients were divided into two groups: ultrasonic bone curette group (group A) and traditional tools group (group B). The operating time, volume of intraoperative blood losing, complications, Japanese Orthopedic Association (JOA) score before and after the operation and improvement rate were recorded in the two groups. The test was used to compare the data between the two groups. In group A, the operating time was (47±7) min, blood loss was (49±4) ml, 1 case experienced urinary tract infection and there was no cerebrospinal fluid leakage or spinal cord injury. In group B, the operating time was (54±12) min and the blood loss was (117±16) ml, cerebrospinal fluid leakage occurred in 2 patients and the incision healed one-stage by local compression, hoarseness happened in 1 case and it disappeared after 2 weeks, 2 patients had swallowing discomfort and recovered in one month, no spinal cord injury occurred in this group. The operating time and blood loss in group A were lower than those in group B (2.691, 20.704, both 0.05). And the incidence of complications in group A were lower than that in group B (χ(2)=4.157, 0.041). The JOA score of group A at 3 days after surgery was improved for 39.0% when compared with that before the surgery, and it was improved for 71.6% at one year after the surgery. The JOA score in group B at 3 days after surgery was elevated for 38.7% from that before the surgery, and it increased for 69.4% at one year after the surgery. There was no significant different in JOA score before the surgery, 3 days and one year after the surgery between the two groups (0.611, 1.076, 0.061, all 0.05). In the process of decompression by resecting osteophytes or bone located at the posterior margin of the vertebral body in the anterior cervical discectomy and fusion surgery, ultrasonic bone curette is safe and effective, and it can effectively shorten the operating time, decrease the blood loss and cut down the incidence of complications.
探讨超声骨刀在前路颈椎间盘切除融合手术中的安全性及有效性。作为一项回顾性研究，我们收集并分析了2014年1月至2017年1月在漯河市中心医院接受前路颈椎间盘切除融合手术的47例患者的临床资料，其中男性26例，女性21例，平均年龄（52±9）岁。根据椎体后缘减压过程中切除骨赘或“倒八字”形骨质所使用的手术工具不同，将患者分为两组：超声骨刀组（A组）和传统工具组（B组）。记录两组的手术时间、术中出血量、并发症情况、术前及术后日本骨科协会（JOA）评分及改善率。采用检验比较两组数据。A组手术时间为（47±7）分钟，出血量为（49±4）毫升，1例发生尿路感染，无脑脊液漏及脊髓损伤。B组手术时间为（54±12）分钟，出血量为（117±16）毫升，2例发生脑脊液漏，经局部压迫切口一期愈合，1例发生声音嘶哑，2周后消失，2例出现吞咽不适，1个月后恢复，该组无脊髓损伤发生。A组的手术时间和出血量均低于B组（分别为2.691、20.704，均P<0.05）。A组并发症发生率低于B组（χ²=4.157，P=0.041）。A组术后3天JOA评分较术前改善39.0%，术后1年改善71.6%。B组术后3天JOA评分较术前升高38.7%，术后1年升高69.4%。两组术前、术后3天及术后1年JOA评分比较差异无统计学意义（分别为0.611、1.076、0.061，均P>0.05）。在前路颈椎间盘切除融合手术中椎体后缘减压切除骨赘或骨质的过程中，超声骨刀安全有效，可有效缩短手术时间、减少出血量并降低并发症发生率。
