超声骨刀辅助后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病的疗效观察

Efficacy of cervical expansive open-door laminoplasty under ultrasound bone curette in the treatment of multilevel cervical spondylotic myelopathy

目的探究超声骨刀(UBC)辅助颈椎后路单开门椎管扩大成形术(CEOL)治疗多节段脊髓型颈椎病(MCSM)的疗效。方法选取2021年9月—2022年11月于兰州大学第二医院接受CEOL治疗的90例MCSM患者,依据UBC应用与否分为UBC组(48例)与常规组(42例)。对比2组围手术期指标、疼痛/功能评分及影像学参数变化。结果UBC组手术时长[(115.00±18.74)min vs.(130.12±23.38)min]、术中失血量[(152.17±27.36)mL vs.(246.39±30.05)mL]及术后引流量[(120.35±21.17)mL vs.(211.06±42.58)mL]均少于常规组(t=3.403、15.568、13.039,P<0.001)。随术后时间推移,视觉模拟评分(VAS)、颈椎后伸活动度(ROM)、颈椎曲度较术前均下降(P<0.05);日本骨科协会(JOA)评分、矢状面轴向距离(SVA)较术前均上升(P<0.05);2组各项评分、影像学参数组间、组间与时间交互作用均无统计学意义(P>0.05)。结论UBC与咬骨钳辅助CEOL治疗均能减轻MCSM患者疼痛,促使脊髓往后漂移,恢复其神经功能,且对颈椎活动度影响较小;相比咬骨钳,UBC能明显缩短手术时长,减少术中失血及术后引流量,但CEOL对患者颈椎矢状面平衡有一定的影响,临床需注意。

Objective To explore the efficacy of cervical expansive open-door laminoplasty(CEOL)under ultrasound bone curette(UBC)in the treatment of multilevel cervical spondylotic myelopathy(MCSM).Methods A total of 90 MCSM patients who received CEOL treatment at the Second Hospital of Lanzhou University from September 2021 to November 2022 were collected and divided into UBC group(48 cases)and conventional group(42 cases)according to whether UBC was used or not.Perioperative indexes,pain/function scores and imaging parameters were compared between the two groups.Results The operation duration[(115.00±18.74)min vs.(130.12±23.38)min],intraoperative blood loss[(152.17±27.36)mL vs.(246.39±30.05)mL]and postoperative drainage volume[(120.35±21.17)mL vs.(211.06±42.58)mL]in UBC group were lower than those in conventional group(t=3.403,15.568,13.039,P<0.001).With the passage of time after surgery,visual analogue score(VAS),cervical posterior extension range of motion(ROM)and cervical curvature all showed a decreasing trend(P<0.05).Japanese Orthopaedic Association(JOA)score,sagittal vertical axis(SVA)and vertebrae-spinal cord posterior margin distance all showed an increasing trend(P<0.05).Differences in the comparison of all scores and imaging parameters between the two groups and on the interaction between the groups and time were not statistically significant(P>0.05).Conclusion UBC and CEOL assisted with bone rongeur can alleviate pain in MCSM patients,promote spinal cord to drift backward,restore nerve function,and have little effect on cervical motion.Compared with bone rongeur,UBC can significantly shorten the duration of operation,reduce intraoperative blood loss and postoperative drainage flow,but CEOL has a certain impact on the cervical sagittal balance of patients,and clinical attention should be paid to it.