超声骨刀在颈椎后路单开门椎管扩大成形术中应用的安全性和有效性

doi:10.19723/j.issn.1671-167X.2018.06.027

摘要/Abstract

摘要：

目的: 探讨超声骨刀在颈椎后路单开门椎管扩大成形术(cervical expansive open-door laminoplasty,CEOL)中应用的安全性和有效性。方法: 回顾2015年3月至2016年3月在北京大学第三医院骨科住院且行CEOL术的94例患者,根据是否使用超声骨刀分为超声骨刀组及传统组,比较两组患者的手术时间、术中出血量、术后第1天引流量、引流管留置天数、脑脊液并发症、手术前后日本骨科协会(Japanese Orthopedic Association, JOA)脊髓功能评分系统(17分法)评分、JOA改善率和术后门轴骨愈合情况。结果: 与传统组相比,超声骨刀组的手术时间延长,但术中出血量、术后第1天引流量、引流管留置天数均明显减少,脑脊液漏的发生率未见明显增加。术后3个月复查,两组患者的JOA改善率差异无统计学意义,但超声骨刀组的门轴骨愈合率较传统组低;术后1年复查,两组患者的JOA改善率和门轴骨愈合率差异均无统计学意义。结论: 在CEOL术中应用超声骨刀安全且有效;与咬骨钳相比,应用超声骨刀虽然导致门轴骨的延迟愈合,但可以减少术中失血、术后引流量和引流管留置时间。

关键词: 超声骨刀, 椎板成形术, 颈椎, 延迟性骨愈合

Abstract:

Objective: To investigate the safety and efficacy of applying ultrasonic osteotome in patients undergoning cervical expansive open-door laminoplasty (CEOL).Methods:In the study , 94 consecutive patients who were administrated in the spine group of Orthopedic Department of Peking University Third Hospital from March 2015 to March 2016 were reviewed retrospectively. All the patients were diagnosed as multilevel cervical spondylosis myelopathy and underwent CEOL. These patients were divided into two groups: ultrasonic osteotome group and traditional group, by whether the ultrasonic osteotome device was used in operation. The parameters we studied were as follows: the duration of operation, blood loss in operation, volume of drainage on the first postoperative day, days of remaining the drainage tube, preoperative and postoperative Japanese Orthopedic Association (JOA) scores, complications of cerebrospinal fluid leak and hinge bone nonunion.Results:Compared with the traditional group, the duration of operation of the ultrasonic osteotome group was increased, but the blood loss in operation, volume of drainage on the 1st postoperative day and days of remaining the drainage tube of the ultrasonic osteotome group were all reduced. There was no obvious difference between the two groups when considering the cerebrospinal fluid leak. At the end of the 3-month follow-up, the JOA score and improvement rate of the JOA score were of no obvious difference between the two groups. But the hinge bone union of the traditional group was better than the ultrasonic osteotome group. At the end of the 12-month follow-up, all the JOA score, the improvement rate of the JOA score and the hinge bone union were not obviously different between the two groups.Conclusion:Applying ultrasonic osteotome in patients undergoing cervical expansive open-door laminoplasty is both safe and effective. Compared with the rongeur, ultrasonic osteotome can cause the delayed union of the hinge bone, but it reduces the blood loss in operation, volume of postoperative drainage and days of remaining the drainage tube.

Key words: Ultrasonic osteotome, Laminoplasty, Cervical vertebrae, Delayed bone union

中图分类号:

R681.53

李彦,姜亮,刘忠军,刘晓光,韦峰,于淼,陶立元. 超声骨刀在颈椎后路单开门椎管扩大成形术中应用的安全性和有效性[J]. 北京大学学报（医学版）, 2018, 50(6): 1092-1097.

Yan LI,Liang JIANG,Zhong-jun LIU,Xiao-guang LIU,Feng WEI,Miao YU,Li-yuan TAO. Efficacy and safety of applying ultrasonic osteotome in cervical expansive open-door laminoplasty[J]. Journal of Peking University(Health Sciences), 2018, 50(6): 1092-1097.

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参考文献 18

[1]	Satomi K, Nishu Y, Kohno T , et al. Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy[J]. Spine, 1994,19(5):507-510. doi: 10.1097/00007632-199403000-00003 pmid: 8184342
[2]	Lee TT, Green BA, Gromelski EB . Safety and stability of open-door cervical expansive laminoplasty[J]. J Spinal Disord, 1998,11(1):12-15. doi: 10.1097/00002517-199802000-00002 pmid: 9493764
[3]	Satomi K, Ogawa J, Ishii Y , et al. Short-term complications and long-term results of expansive open-door laminoplasty for cervical stenotic myelopathy[J]. Spine J, 2001,1(1):26-30. doi: 10.1016/S1529-9430(01)00008-0 pmid: 14588365
[4]	Hu X, Ohnmeiss DD, Lieberman IH . Use of an ultrasonic osteotome device in spine surgery: experience from the first 128 patients[J]. Eur Spine J, 2013,22(12):2845-2849. doi: 10.1007/s00586-013-2780-y pmid: 23584231
[5]	Grauvogel J, Scheiwe C, Kaminsky J . Use of Piezosurgery for removal of retrovertebral body osteophytes in anterior cervical discectomy[J]. Spine J, 2014,14(4):628-636. doi: 10.1016/j.spinee.2013.06.085 pmid: 24314765
[6]	刘鑫, 王翔宇, 温冰涛 , 等. 超声骨刀在颈椎前路椎体次全切除术中应用的安全性和有效性评价[J]. 中国脊柱脊髓杂志, 2018,28(4):303-308.
[7]	Rhee JM, Register B, Hamasaki T , et al. Plate-only open door laminoplasty maintains stable spinal canal expansion with high rates of hinge union and no plate failures[J]. Spine, 2011,36(1):9-14. doi: 10.1097/BRS.0b013e3181fea49c pmid: 21192219
[8]	Horton JE, Tarpley TM Jr, Jacoway JR . Clinical applications of ultrasonic instrumentation in the surgical removal of bone[J]. Oral Surg Oral Med Oral Pathol, 1981,51(3):236-242. doi: 10.1016/0030-4220(81)90051-7 pmid: 6938883
[9]	Nakase H, Matsuda R, Shin Y , et al. The use of ultrasonic bone curettes in spinal surgery[J]. Acta Neurochir (Wien), 2006,148(2):207-212. doi: 10.1007/s00701-005-0655-7 pmid: 16311841
[10]	Parker SL, Kretzer RM, Recinos PF , et al. Ultrasonic BoneScalpel for osteoplastic laminoplasty in the resection of intradural spinal pathology: case series and technical note[J]. Neurosurgery, 2013,73(1):61-66. doi: 10.1227/NEU.0b013e318283c98b pmid: 23262563
[11]	Al-Mahfoudh R, Qattan E, Ellenbogen JR , et al. Applications of the ultrasonic bone cutter in spinal surgery: our preliminary experience[J]. Br J Neurosurg, 2014,28(1):56-60. doi: 10.3109/02688697.2013.812182 pmid: 23841662
[12]	Li K, Zhang W, Li B , et al. Safety and efficacy of cervical lami-noplasty using a Piezosurgery device compared with a high-speed drill[J]. Medicine (Baltimore), 2016,95(37):e4913. doi: 10.1097/MD.0000000000004913 pmid: 5402611
[13]	陈颖, 罗晓宁, 史文勇 , 等. 超声手术刀的研制现状与应用[J]. 生物医学工程学杂志, 2005,22(2):377-380. doi: 10.3321/j.issn:1001-5515.2005.02.038
[14]	Zhou Y, Gao XW . Effect of hydrodynamic cavitation in the tissue erosion by pulsed high-intensity focused ultrasound (pHIFU)[J]. Phys Med Biol, 2016,61(18):6651-6667. doi: 10.1088/0031-9155/61/18/6651 pmid: 27541633
[15]	Chiriac G, Herten M, Schwarz F , et al. Autogenous bone chips: influence of a new piezoelectric device (Piezosurgery) on chip morphology, cell viability and differentiation[J]. J Clin Periodontol, 2005,32(9):994-999. doi: 10.1111/j.1600-051X.2005.00809.x pmid: 16104964
[16]	Sirolli M, Mafra CE, Santos RA , et al. Influence of piezosurgery on bone healing around titanium implants: a histological study in rats[J]. Braz Dent J, 2016,27(3):278-283. doi: 10.1590/0103-6440201600161 pmid: 27224560
[17]	Stelzle F, Frenkel C, Riemann M , et al. The effect of load on heat production, thermal effects and expenditure of time during implant site preparation: an experimental ex vivo comparison between piezosurgery and conventional drilling[J]. Clin Oral Implants Res, 2014,25(2):140-148. doi: 10.1111/clr.12458_134
[18]	Hollstein S, Hoffmann E, Vogel J , et al. Micromorphometrical analyses of five different ultrasonic osteotomy devices at the rabbit skull[J]. Clin Oral Implants Res, 2012,23(6):713-718. doi: 10.1111/j.1600-0501.2011.02185.x pmid: 21488969

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Items	Traditional group (n=43)	Ultrasonic osteotome group (n=51)	P value
General information
Male :Female	28 :15	36 :15	0.571
Age/years	58.0±12.5	53.8±11.0	0.080
Preoperative JOA score	11.5 (9.0, 13.5)	12.0 (9.5, 14.0)	0.401
No. of decompressive segments	5.0 (5.0, 5.0)	5.0 (5.0, 5.0)	0.082
Perioperative parameters
Duration of operation/min	97.0 (77.0, 114.0)	108.0 (96.0, 134.0)	0.006
Blood loss/mL	200.0 (150.0, 300.0)	150.0 (100.0, 200.0)	0.016
Volume of drainage at the 1^st postoperative day/mL	210.0 (160.0, 260.0)	80.0 (50.0, 105.0)	<0.001
Days of remaining the drainage tube	3.0 (3.0, 4.0)	3.0 (2.0, 3.0)	0.001

Items	Traditional group		Ultrasonic osteotome group		P value
Items	n	Value	n	Value	P value
JOA score
3 months follow-up	24	15.3 (13.0, 16.0)	32	15.0 (13.5, 16.0)	0.948
12 months follow-up	12	15.8 (12.5, 16.5)	13	15.5 (14.0, 16.5)	0.975
Improving rate of JOA score/%
3 months follow-up	24	53.6 (20.0, 78.6)	32	50.0 (34.9, 65.5)	0.932
12 months follow-up	12	65.7 (28.6, 92.3)	13	68.4 (50.0, 80.0)	0.863

	Traditional group	Ultrasonic osteotome group	P value
C4 at 3 months follow-up			<0.001
Healed	16	4
Partial healed	1	3
Not healed	7	25
C5 at 3 months follow-up			0.026
Healed	11	8
Partial healed	6	4
Not healed	7	20
C6 at 3 months follow-up			0.078
Healed	14	13
Partial healed	6	6
Not healed	4	13
C4 at 12 months follow-up			0.595
Healed	11	11
Partial healed	1	2
Not healed	0	0
C5 at 12 months follow-up			0.208
Healed	11	10
Partial healed	1	1
Not healed	0	2
C6 at 12 months follow-up			0.436
Healed	11	11
Partial healed	1	1
Not healed	0	1