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Journal of Peking University(Health Sciences) ›› 2018, Vol. 50 ›› Issue (6): 1092-1097. doi: 10.19723/j.issn.1671-167X.2018.06.027

• Article • Previous Articles     Next Articles

Efficacy and safety of applying ultrasonic osteotome in cervical expansive open-door laminoplasty

Yan LI,Liang JIANG(),Zhong-jun LIU,Xiao-guang LIU,Feng WEI,Miao YU,Li-yuan TAO   

  1. 1.Department of Orthopedics, 2.Research Center of Clinical Epidemicology, Peking University Third Hospital, Beijing 100191, China
  • Received:2018-08-16 Online:2018-12-18 Published:2018-12-18
  • Contact: Liang JIANG E-mail:jiangliang@bjmu.edu.cn
  • Supported by:
    Supported by Capital Clinical Distinctive Application Research(Z171100001017090)

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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

CLC Number: 

  • R681.53

Figure 1

Classification of hinge bone unionA, hinge bone union; B, hinge bone partial union; C, hinge bone nonunion"

Table 1

General information and perioperative parameters of the two groups"

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 1st 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

Table 2

Comparison of the JOA scoring between the two groups"

Items Traditional group Ultrasonic osteotome group P value
n Value n 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

Table 3

Comparison of the hinge bone union between the two groups"

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
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