超声骨刀与高速磨钻在胸椎管狭窄症术中应用的对比研究

Comparative Study of Ultrasonic Bone Knife and High Speed Grinding in Application of Thoracic Spinal Stenosis

目的:探讨超声刀减压与传统磨钻减压在胸椎管狭窄症手术治疗的效果和安全性;方法:回顾性分析2017年1月~2018年1月本院收治的胸椎管狭窄症患者18例,其中男10例,女8例,年龄38~76岁,平均(50.5±7.5)岁,病程6~72个月,平均(20.5±15.5)个月。狭窄节段:T2、T3、8例;T8、T9、4例;T11、T12、6例;随访时间6~12个月,平均(9.4±2)个月。术前Frankel(脊髓功能分级):B级:10例;C级:4例;D级:4例;采用JOA评分系统评估术后疗效,根据患者手术方式选择随机分为两组:A组(超声刀组)、B组(磨钻组),比较两组术前术后疗效及随访愈后情况。结果:手术均在全麻下进行,A组手术时间(2.5±1.0)h;术中出血量(500±180)mL,B组手术时间(5.5±1.0)h,术中出血量(800±270)mL,两组术中用时及出血量有统计学意义(P<0.05);末次随访JOA评分:A组(4.26±1.0),B组(4.24±1.1);两组间比较无统计学意义(P>0.05)。结论:超声刀减压与传统磨钻减压治疗胸椎管狭窄症具有提高手术安全性高、降低手术风险及复杂程度,并发症低、手术用时及出血量少等优点,可取得满意临床效果。

Objective:To investigate the effect and safety of ultrasonic knife decompression and traditional drill decompression in the surgical treatment of thoracic spinal stenosis.Methods:A retrospective analysis of 18 patients with thoracic spinal stenosis admitted to our hospital from January 2017 to January 2018,including 10 males and 8 females,aged from 38 to 76 years,with an average of(50.5±7.5)years old.The course of illness was 6 to 72 months,with an average of(20.5±15.5)months.The stenosis segment:T2,T3,8 cases;T8,T9,4 cases;T11,T12,6 cases;follow-up time 6-12 months,average(9.4±2)months.Preoperative Frankel(grade of spinal cord function):Grade B:10 cases;Grade C:4 cases;Grade D:4 cases;JOA scoring system was used to evaluate the postoperative curative effect,and the patients were randomly divided into two groups according to the surgical method:Group A(ultrasonic knife group),group B(drilling drill group),compare the preoperative and postoperative curative effect and follow-up and recovery of the two groups.Results:All operations were performed under general anesthesia.The operation time of group A was(2.5±1.0)h;the blood loss during operation was(500±180)mL,the operation time of group B was(5.5±1.0)h,and the blood loss during operation was(800±270)mL,the operation time and blood loss of the two groups were statistically significant(P<0.05);the last follow-up JOA score:group A(4.26±1.0),group B(4.24±1.1);the comparison between the two groups was not statistically significant(P>0.05).Conclusion:Ultrasonic knife decompression and traditional drill-grinding decompression for thoracic spinal stenosis have the advantages of improving surgical safety,reducing surgical risk and complexity,low complications,surgical time and bleeding,and can achieve satisfactory clinical results.