摘要
目的探讨超声骨刀联合微型支撑钛板在颈椎后路单开门椎管扩大成形术中治疗无骨折脱位颈脊髓损伤的应用效果,并分析其与传统颈椎后路在有效性、安全性方面的差异。方法回顾性分析2019年2月—2022年1月北京市顺义区医院骨一科收治的因无骨折脱位颈脊髓损伤行颈椎后路单开门椎管扩大成形术的76例患者临床资料。其中男性46例,女性30例;年龄55~67岁,平均61.9岁;致伤原因:高处坠落伤11例,道路交通伤26例,摔伤39例。根据手术操作方式不同分为两组:A组(39例)应用三角形超声骨刀制作门轴、片状刀头切开开门侧椎板,采用微型钛板固定开门后的椎板;B组(37例)应用三关节咬骨钳制作门轴及咬开开门侧椎板,采用微型钛板固定开门后的椎板。统计两组的手术时间、术中出血量、术后切口引流量、日本骨科学会(Japanese Orthopedics Association,JOA)评分、颈椎管矢状径手术前后差值。结果两组在年龄、性别、体质量指数、致伤原因及术前JOA评分方面比较,差异均无统计学意义(P>0.05)。A组术中出血量及术后伤口引流量显著少于B组[(150.3±35.6)mL vs.(276.4±43.1)mL、(115.8±20.2)mL vs.(210.7±54.2)mL],差异有统计学意义(P<0.05);A组手术时间短于B组[(114.9±18.3)min vs.(168.8±24.4)min],差异有统计学意义(P<0.05);两组术后JOA评分较术前均有明显改善[(15.3±1.1)分vs.(8.9±0.3)分、(14.6±1.2)分vs.(9.1±0.4)分],差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05);两组颈椎管矢状径手术前后差值[(6.2±0.7)mm vs.(5.8±0.8)mm]比较,差异无统计学意义(P>0.05)。结论颈椎后路单开门椎管扩大成形术在治疗无骨折脱位颈脊髓损伤,JOA评分改善明显,应用超声骨刀联合微型钛板可以明显减少出血量、缩短手术时间。
Objective To investigate the effect of ultrasonic bone scalpel combined with supporting titanium mini plates in the treatment of cervical spinal cord injuries(SCIs)without fractures or dislocations by posterior cervical single door laminoplasty,and to explore the differences with traditional posterior approach to the cervical spine in terms of effectiveness and safety.Methods A retrospective analysis was conducted on the clinical data of 76 SCI patients without fractures or dislocations(including 46 males and 30 females aged 55-67 years,mean 61.9 years)who underwent posterior cervical laminoplasty from Feb.2019 to Jan.2022 at Department of Orthopaedics,Shunyi District Hospital in Beijing.The causes of SCIs included 11 falls from height,26 road traffic accidents,and 39 ground-level falls.Patients were divided into Group A(triangle ultrasonic bone scalpel was used to make the door shaft and slice the vertebral plate on the opening side,n=39)and Group B(three joint bone biting forceps were used to make the door shaft and open the vertebral plate on the opening side,n=37).For both groups,the titanium mini plate was chosen to fix the vertebral plate after opening the door.The following parameters were collected and analyzed:operation time,intraoperative bleeding,postoperative drainage volume from the surgical incision,Japanese Orthopedics Association(JOA)score,and difference in the sagittal diameter of the cervical spine before and after surgery.Results The two group was comparable in age,gender,body mass index,injury causes,and preoperative JOA scores(all P>0.05).Compared with Group B,Group A showed significantly lower intraoperative bleeding(mL,150.3±35.6 vs.276.4±43.1)and postoperative wound drainage(mL,115.8±20.2 vs.210.7±54.2,both P<0.05)and shorter operation time(min,114.9±18.3 vs.168.8±24.4,P<0.05).The postoperative JOA scores of both groups were significantly improved compared with that before surgery(15.3±1.1 vs.8.9±0.3 for Group A and 14.6±1.2 vs.9.1±0.4 for Group B,both P<0.05),but the difference
作者
张宏志
王晓宇
Zhang Hongzhi;Wang Xiaoyu(Department of Orthopaedics,Shunyi District Hospital of Beijing,Beijing 101300,China)
出处
《创伤外科杂志》
2023年第12期924-928,933,共6页
Journal of Traumatic Surgery
关键词
脊髓损伤
超声骨刀
微型钛板
颈椎后路单开门椎管扩大成形术
Spinal cord injuries
Ultrasonic bone scalpel
Titanium mini plate fixation
Single door cervical laminoplasty
