3D数字化技术联合超声骨刀治疗胸椎黄韧带骨化症的疗效及安全性分析

Efficacy and safety of 3D digital technology combined with ultrasonic osteotome in the treatment of thoracic ossification of ligamentum flavum

目的 探讨术前3D数字化技术联合超声骨刀在胸椎黄韧带骨化症(thoracicossification of ligament flavum, TOLF)行椎板切除减压手术中的应用效果和安全性。方法 选择2017年3月~2020年3月就诊于本院并接受椎板切除减压手术治疗的41例TOLF患者作为研究对象,依据术中行椎板切除时的操作方案不同分成两组:研究组19例,采用3D数字化超声骨刀行椎板切除;对照组22例,采用磨钻行椎板切除。对两组患者的围术期指标、手术前后JOA评分及其改善率、并发症情况进行比较。结果 研究组单节椎板切除时间显著短于对照组,术中失血量显著少于对照组(P<0.05)。与术前相比,两组患者术后1年的JOA评分均有显著提高(P<0.05),且研究组术后1年的JOA评分和JOA改善率均显著高于对照组(P<0.05)。研究组并发症发生率为15.8%,对照组为36.4%,差异有统计学意义(P<0.001)。结论 将3D数字化超声骨刀技术应用于TOLF椎板切除减压,可取得良好效果,手术耗时、术中出血量和术后并发症明显减少,提高了手术安全性。

Objective To investigate the effect of preoperative 3 D digital technology combined with ultrasonic osteotome in laminectomy and decompression of thoracic ossification of ligamentum flavum(TOLF). Methods From March 2017 to March 2020, 41 patients with TOLF who underwent laminectomy and decompression in our hospital were selected in this research. They were divided into two groups according to the operation scheme of laminectomy during operation: 19 patients in the study group underwent laminectomy with 3 D digital ultrasonic osteotome;22 cases in the control group underwent laminectomy with traditional grinding drill. The perioperative indicators, JOA score before and after operation, improvement rate and complications of the two groups were compared. Results The time of single segment laminectomy in the study group was significantly shorter than that in the control group, and the intraoperative blood loss was significantly less than that in the control group(P<0.05). Compared with before operation, the JOA scores of the two groups were significantly improved at one year after operation(P<0.05), and the JOA scores and JOA improvement rate of the study group were significantly higher than those of the control group at one year after operation(P<0.05). The incidence rate of complications was 15.8% in the study group, and that was 36.4% in the control group, with a statistically significant difference(P<0.001). Conclusion The application of 3 D digital ultrasonic osteotome technology in laminectomy and decompression of TOLF can achieve good results, reduce operation time and intraoperative bleeding, and improve operation safety on the premise of ensuring decompression effect.