摘要
目的评估超声骨刀在脊柱结核后路病灶清除椎间植骨融合内固定手术中的应用效果及患者预后情况。方法回顾性分析自2017-01—2020-07采用脊柱后路病灶清除椎间植骨融合内固定治疗的28例脊柱结核,12例术中使用超声骨刀(超声骨刀组),12例术中使用常规骨刀(常规骨刀组)。比较两组手术时间、术中出血量、植骨融合情况、脊髓神经功能恢复情况,术后疼痛VAS评分、ODI指数、手术节段Cobb角。结果28例均获得随访,随访时间平均20(12~36)个月。超声骨刀组10例植骨融合为优,2例植骨融合欠佳;常规骨刀组13例植骨融合为优,3例植骨融合欠佳;组间植骨融合情况差异无统计学意义(P>0.05)。所有患者脊髓神经功能均较术前改善,超声骨刀组与常规骨刀组末次随访时脊髓神经功能ASIA分级差异无统计学意义(P>0.05)。超声骨刀组手术时间较常规骨刀组短,术中出血量较常规骨刀组少,差异有统计学意义(P<0.05)。超声骨刀组与常规骨刀组术后6个月、末次随访时疼痛VAS评分、ODI指数、手术节段Cobb角比较差异无统计学意义(P>0.05)。结论病灶清除、植骨、重建椎体稳定是脊柱结核手术治疗的关键环节,术中使用超声骨刀切割骨质的切缘平整,有利于制备支撑骨块及修整植骨面,可在保证手术安全的基础上提高手术效率。
Objective To evaluate the application effect of ultrasound osteotome in debridement,intervertebral bone grafting,fusion and internal fixation for spinal tuberculosis via posterior approach and the prognosis.Methods A retrospective analysis of 28 patients who underwent posterior spinal surgery for spinal tuberculosis from January 2017 to July 2020 was conducted.Patients were divided into two groups according to the different tools in surgery.There were 12 cases in ultrasound osteotome group and 16 cases in conventional osteotome group.The operation time,intraoperative blood loss,visual analog score and the Oswestry disability index postoperative,changes in Cobb angle,postoperative fusion rate and recovery of spinal nerve function were observed and recorded in the two groups.Results All cases were followed up for 12-36 months with 20 months on average.Ten cases showed excellent bone graft fusion,while 2 cases showed poor bone graft fusion in the ultrasound osteotome group.In the conventional osteotome group,13 cases had excellent bone graft fusion,while 3 cases had poor bone graft fusion.There was no statistically significant difference in bone graft fusion between groups(P>0.05).The spinal nerve function of all patients was improved after operation and there was no statistically significant differences in ASIA grading at the last follow-up(P>0.05).The differences in operation time and blood loss between the two groups were statistically significant(P<0.05).There were no significant differences in VAS,ODI,Cobb angle correction at six months after surgery and last follow-up(P>0.05).Conclusion The debridement,bone grafting and reconstruction of vertebral stability are key steps in the surgical treatment of spinal tuberculosis.The use of ultrasound osteotome during surgery to cut the bone with a flat cutting edge is beneficial for preparing supporting bone blocks and repairing the bone grafting surface which can improve efficiency while ensuring surgical safety.
作者
吴浙栋
夏平
冯晶
刘伟
WU Zhedong;XIA Ping;FENG Jing;LIU Wei(Department of Spine Surgery,Wuhan Orthopaedics Hospital of Integrated Traditional Chinese and Western Medicine,the Affiliated Hospital of Wuhan Sports University,Wuhan,Hubei 430079,China;不详)
出处
《中国骨与关节损伤杂志》
2023年第7期689-693,共5页
Chinese Journal of Bone and Joint Injury
关键词
脊柱结核
脊柱后路手术
超声骨刀
椎间融合
植骨
Spinal tuberculosis
Posterior spinal surgery
Ultrasonic osteotome
Lumber intervertebral fusion
Bone grafting
