应用超声骨刀与气动磨钻行椎板切除减压治疗胸椎黄韧带骨化症的疗效比较

Comparison of the efficacy of ultrasonic bone curette and pneumatic honing in laminectomy and decompression for ossification of the thoracic ligamentum flavum

目的比较经超声骨刀与传统气动磨钻治疗胸椎黄韧带骨化症(TOLF)的疗效。方法回顾分析2015年10月至2017年10月吉林大学中日联谊医院应用超声骨刀或气动磨钻行胸椎椎板切除减压手术治疗的74例TOLF患者的病历资料。根据手术器械的不同分为超声骨刀组(21例)和气动磨钻组(53例)。分别记录2组患者的手术时间、术中出血量、并发症发生率及住院时间,并采用日本骨科协会(JOA)评分标准评估神经功能改善率。结果随访1年以上。超声骨刀组术中单节段出血量为(129.44±40.27)ml,手术时间为(6.09±2.27)min;气动磨钻组术中单节段出血量为(186.28±35.46)ml,手术时间为(9.92±3.70)min,2组术中单节段出血量与手术时间的差异均有统计学意义(P均<0.05)。超声骨刀组术中出现4例(19.05%)硬膜损伤或脑脊液漏,气动磨钻组术中出现11例(20.75%)硬膜损伤、脑脊液漏或脊髓损伤,2组并发症发生率差异无统计学意义(P=0.948)。超声骨刀组住院时间为(19.24±7.87)d,气动磨钻组为(20.64±7.14)d,2组差异无统计学意义(P=0.461)。术后1年,超声骨刀组JOA评分为(9.24±1.48)分,气动磨钻组为(8.92±1.94)分,2组差异无统计学意义(P=0.507)。结论与气动磨钻相比,应用超声骨刀行胸椎椎板切除减压手术治疗TOLF具有手术时间短和术中出血量少的优势。

Objective To compare the efficacy of ultrasonic bone curette and pneumatic honing in laminectomy and decompression for ossification of the thoracic ligamentum flavum.MethodsThe medical record informations of 74 patients with ossification of the thoracic ligamentum flavum treated by ultrasonic bone curette or pneumatic honing from October 2015 to October 2017 in the China-Japan Union Hospital of Jilin University were retrospectively analyzed.All patients were divided into ultrasonic bone curette group（21cases）and pneumatic honing group（53 cases）according to different surgical instruments.The operation time,intraoperative blood loss,incidence of complications and hospital length of stay（LOS）of the 2 groups were measured,and the neurological improvement rate was evaluated by Japanese Orthopaedic Association（JOA）score.Results The follow-up time was more than one year.The blood loss of the single segment was（129.44±40.27）ml in the ultrasonic bone curette group and（186.28±35.46）ml in the pneumatic honing group;the operation time was（6.09±2.27）min in the ultrasonic bone curette group and（9.92±3.70）min in the pneumatic honing group.There were statistically significant difference between the 2 groups（all P〈0.05）.There were 4 cases（19.05%）of dural injury or cerebrospinal fluid leakage in the ultrasonic bone curette group.There were 11 cases（20.75%）of dural injury,cerebrospinal fluid leakage or spinal cord injury in the pneumatic honing group.And there was no significant difference between the 2 groups（P=0.948）.The LOS was（19.24±7.87）d in the ultrasonic bone curette group and（20.64±7.14）d in the pneumatic honing group,and there was no significant difference between the 2 groups（P=0.461）.One year after surgery,the JOA score was（9.24±1.48）in the ultrasonic bone curette group and（8.92±1.94）in the pneumatic honing group,and there was no significant difference between the 2 groups（P=0.507）.ConclusionCompared with pneumatic honing,the ultrasonic bone curette in laminectomy and decompression for ossification of the thoracic ligamentum flavum may achieve shorter operation time and less intraoperative blood loss.