超声骨刀多节段截骨治疗脊柱退变性侧后凸

Piezosurgery multiple osteotomies for degenerative kyphoscoliosis of spine

[目的]评价超声骨刀多节段截骨治疗脊柱退变性侧后凸畸形经关节突截骨术(SPO)的应用效果。[方法]回顾2015年1月~2018年1月120例手术治疗的脊柱退变性侧后凸畸形患者的临床资料,均采用SPO术治疗,其中72例术中采用超声骨刀进行截骨,48例术中采用常规高速磨钻进行截骨。比较两组围手术期、随访与影像资料。[结果]超声骨刀组手术时间、单节段截骨时间、出血量、住院时间均显著优于常规组(P<0.05)。随时间推移,两组患者VAS评分显著下降(P<0.05),而JOA评分显著增加(P<0.05);但是,相应时间点两组间JOA评分、VAS评分差异均无统计学意义(P>0.05)。影像方面,术后两组患者后凸Cobb角、侧弯Cobb角和SVA均较术前显著减少(P<0.05),相应时间点,两组间影像指标的差异均无统计学意义(P>0.05)。[结论]超声骨刀多节段截骨治疗脊柱退变性侧后凸畸形可减少截骨与手术时间,降低术中出血量。

[Objective]To evaluate the clinical outcomes of piezosurgery multiple osteotomies for degenerative kyphoscoliosis of spine.[Methods]A retrospective study was conducted on 120 patients who underwent surgical treatment for degenerative kyphoscoliosis from January 2015 to January 2018.All the patients received multiple Smith-Petersen osteotomies(SPO)and instrumented fusion,including 72 patients with piezosurgery device and 48 patients with conventional high-speed burr used for osteotomy.The perioperative,follow up and imaging documents were compared between the two groups.[Results]The piezosurgery group proved significantly superior to the conventional group regarding to total operation time,time consumed in singlesegment osteotomy,intraoperative blood loss and hospital stay(P<0.05).As time went the VAS score significantly decreased,while the JOA score significantly increased in both groups(P<0.05).The piezosurgery group was significantly superior to the conventional group in VAS score at 7 days postoperatively(P<0.05).However,no statistical differences were noticed between the two groups in JOA scores at any corresponding time point(P>0.05).In term of radiographic measurements,the kyphotic Cobb’s angle,scoliotic Cobb’s angle and distance in sagittal vertical axis significantly improved postoperatively compared with those before operation in both groups(P<0.05).However,no statistical differences were noticed between the two groups in aforesaid radiographic parameters at any corresponding time point(P>0.05).[Conclusion]The piezosurgery device used in multiple osteotomies does shorten the total operation time and the time consumed for osteotomy,reduce intraoperative blood loss.