超声骨刀辅助对称减压改良腰椎管扩大成形术的临床应用分析

Clinical application of ultrasound bone cutter-assisted symmetrical decompression and modified lumbar canal enlargement in the treatment of lumbar spinal stenosis

目的:探究超声骨刀辅助内聚式对称减压人工诱导突出椎间盘自然回缩术治疗腰椎椎管狭窄症的效果。方法:回顾性抽取2022年9月至2023年11月于郑州大学第一附属医院接受手术治疗的70例腰椎椎管狭窄患者,依据超声骨刀应用与否分为超声骨刀组(35例)与常规对照组(35例)。超声骨刀组术中应用超声骨刀行椎板切除减压操作,常规对照组应用椎板咬骨钳等传统工具行手动椎板减压操作。比较两组围手期指标(手术时长、术中出血量、术后24 h引流量)及手术前后视觉模拟评分法(VAS)评分及Oswestry功能障碍指数(ODI)。结果:超声骨刀组手术时长、术中出血量、术后24 h引流量[(93.66±18.76)min、(78.71±44.03)mL、(54.57±21.84)mL]均少于常规组[(166.23±44.24)min、(257.71±105.47)mL、(159.43±50.17)mL],P均<0.05。术后1周及术后3、6个月,两组VAS评分及ODI均低于术前,但组间比较差异未见统计学意义(P>0.05)。两组患者术后均未出现脑脊液漏、脊髓损伤、硬膜囊损伤等并发症。结论:超声骨刀辅助内聚式对称减压改良椎管扩大成形术可缩短手术时间,降低术中出血量及术后24 h引流量,其应用符合腰椎椎管狭窄症治疗共识所提出的原则,加速患者术后康复,对比传统方法具有其独特优势。

Objective:To investigate the effect of ultrasound bone cutter-assisted concentric symmetrical decompression combined with artificially induced spontaneous retraction of herniated intervertebral discs in the treatment of lumbar spinal stenosis.Methods:Seventy patients with lumbar spinal stenosis who received surgical treatment in the First Affiliated Hospital of Zhengzhou University from September 2022 to November 2023 were retrospectively selected,and they were divided into the ultrasonic bone cutter group(35 cases)and the conventional control group(35 cases)according to application of ultrasonic bone cutter.The ultrasonic bone cutter group was treated by laminectomy decompression with ultrasonic bone cutter during surgery,while the conventional control group was treated by manual decompression with conventional vertebral lamina bone nippers.The perioperative indicators(operation duration,intraoperative blood loss,24-hour postoperative drainage volume),preoperative and postoperative scores of visual analog scale(VAS)and Oswestry disability index(ODI)were compared between the two groups.Results:The operation duration,intraoperative blood loss,and 24-hour postoperative drainage volume of the ultrasonic bone cutter group were(93.66±18.76)min,(78.71±44.03)mL and(54.57±21.84)mL,respectively,which were less than the(166.23±44.24)min,(257.71±105.47)mL,and(159.43±50.17)mL of the conventional group(P<0.05).One week,3 months and 6 months after surgery,the VAS scores and ODI of both groups were lower than those before surgery,but there was no statistically significant difference between the two groups(P>0.05).No postoperative complication,such as cerebrospinal fluid leakage,spinal cord injury,or dural sac injury,was found in either group.Conclusions:Ultrasound bone cutter-assisted concentric symmetrical decompression combined with artificially induced spontaneous retraction of herniated intervertebral discs can significantly reduce operation duration,intraoperative blood loss,and 24-hour postoperative drainage volume.It aligns with the principles proposed in the consensus on the treatment of lumbar spinal stenosis;moreover,it can accelerate postoperative recovery,and demonstrate unique advantages compared with traditional methods.