超声骨刀截骨和高速磨钻截骨行颈后路单开门椎管扩大成形微型钛板内固定治疗多节段脊髓型颈椎病的对比研究

A comparison of piezosurgery and high-speed grinding drill for osteotomy in unilateral open-door laminopl asty and miniature titanium plates internal fixation through cervical posterior approach for treatment of multisegment cervical spondylotic myelopathy

目的:比较超声骨刀截骨和高速磨钻截骨行颈后路单开门椎管扩大成形微型钛板内固定治疗多节段脊髓型颈椎病的早期临床疗效与安全性。方法:回顾性分析46例多节段脊髓型颈椎病患者的病例资料,均采用颈后路单开门椎管扩大成形微型钛板内固定治疗,术中采用超声骨刀截骨24例(超声骨刀截骨组)、采用高速磨钻截骨22例(高速磨钻截骨组)。比较2组患者手术时间、术中出血量、术后引流量、并发症发生情况、术后1周日本骨科学会(JapaneseOrthopaedicAssociation,JOA)脊髓型颈椎病评分及JOA脊髓型颈椎病评分改善率。结果:①一般指标。2组患者手术时间和术中出血量比较,组间差异无统计学意义[(141.21±19.33)min,(158.42±28.10)min,t=1.543,P=0.101;(180.00±56.26)mL,(204.55±60.92)mL,t=1.412,P=0.162];超声骨刀截骨组术后引流量少于高速磨钻截骨组[(155.43±73.06)mL,(224.37±84.11)mL,t=2.209,P=0.039]。②JOA脊髓型颈椎病评分。术前及术后1周,2组患者JOA脊髓型颈椎病评分比较,组间差异均无统计学意义[(9.3±3.1)分,(9.1±3.4)分,t=1.024,P=0.313;(14.5±1.2)分,(14.3±1.4)分,t=0.113,P=0.901];术后1周,2组患者JOA脊髓型颈椎病评分均高于术前(t=320.327,P=0.002;t=128.604,P=0.005)。③JOA脊髓型颈椎病评分改善率。术后1周,2组患者JOA脊髓型颈椎病评分改善率比较,差异无统计学意义[(63.12±16.32)%,(61.44±17.17)%,t=0.733,P=0.421]。④安全性。2组均未发生神经损伤、脑脊液渗漏等并发症。结论:采用超声骨刀截骨和高速磨钻截骨行颈后路单开门椎管扩大成形微型钛板内固定治疗多节段脊髓型颈椎病,手术时间、术中出血量、早期临床疗效和安全性相当,但前者术后引流量少。

Objective:To compare the early clinical curative effects and safety of piezosurgery versus high-speed grinding drill for osteotomy in unilateral open-door laminoplasty and miniature titanium plates internal fixation through cervical posterior approach for treatment of multisegment cervical spondylotic myelopathy(CSM).Methods:The medical records of 46 patients with multisegment CSM were analyzed retrospectively.All patients were treated with unilateral open-door laminoplasty and miniature titanium plates internal fixation through cervical posterior approach, and the piezosurgery and high-speed grinding drill were used for osteotomy during the surgery in 24 patients(piezosurgery group)and 22 patients(high-speed grinding drill group)respectively.The operative time, intraoperative blood loss, postoperative drainage volume, complications, Japanese Orthopaedic Association(JOA)CSM scores and improvement rate of JOA CSM scores measured at 1 week after the surgery were compared between the 2 groups.Results:There was no statistical difference in operative time and intraoperative blood loss between the 2 groups(141.21±19.33 vs 158.42±28.10 minutes, t=1.543,P=0.101;180.00±56.26 vs 204.55±60.92 mL,t=1.412,P=0.162).The postoperative drainage volume was less in piezosurgery group compared to high-speed grinding drill group(155.43±73.06 vs 224.37±84.11 mL,t=2.209,P=0.039).There was no statistical difference in JOA CSM scores between the 2 groups before the surgery and at 1 week after the surgery(9.3±3.1 vs 9.1±3.4 points, t=1.024,P=0.313;14.5±1.2 vs 14.3±1.4 points, t=0.113,P=0.901).The JOA CSM scores increased in the 2 groups at 1 week after the surgery compared to pre-surgery(t=320.327,P=0.002;t=128.604,P=0.005).There was no statistical difference in improvement rate of JOA CSM scores between the 2 groups at 1 week after the surgery(63.12±16.32 vs 61.44±17.17 %,t=0.733,P=0.421).No complications such as nerve injuries and cerebrospinal fluid leakage were found in the 2 groups.Conclusion:Osteotomy using piezosurgery is similar to osteotomy using high-speed grinding drill in operative time, intraoperative blood loss, early clinical curative effects and safety in unilateral open-door laminoplasty and miniature titanium plates internal fixation through cervical posterior approach for treatment of multisegment CSM,while the former has less postoperative drainage volume compared to the latter.