超声骨刀在退变性胸腰椎侧后凸畸形截骨矫形术中的应用

摘要

目的 探讨超声骨刀在退变性胸腰椎侧后凸畸形截骨矫形术应用中的有效性及安全性.方法 回顾性分析2013年3月—2015年6月本院确诊为胸腰椎退变性侧后凸畸形且采用多节段经关节突截骨术(SPO)治疗的43例患者临床资料,其中超声骨刀组(19例)、高速磨钻组(24例).分析对比两组手术截骨节段、单节段截骨时间、术中出血量、术后引流量、住院时间、侧凸Cobb角、后凸Cobb角、矢状面C7铅垂线与骶骨后上缘间水平距离(SVA)改变情况、日本骨科学会(JOA)评分及JOA改善率、视觉模拟量表(VAS)评分、围手术期并发症发生率等指标.结果 43例患者手术均顺利完成.两组单节段截骨时间、术中出血量、术后引流量及住院时间比较,超声骨刀组均优于高速磨钻组,差异有统计学意义(P<0.05).两组患者术后脊柱序列恢复满意,侧后凸及SVA矫正率差异无统计学意义(P>0.05).两组患者术后神经功能均明显改善,术后JOA评分改善率、VAS评分改善率两组间比较差异均无统计学意义(P>0.05).两组术中均未出现神经损伤等手术并发症,高速磨钻组出现硬膜囊损伤脑脊液漏2例.结论 应用超声骨刀可以安全、有效地完成退变性胸腰椎侧后凸畸形的截骨矫形手术.与高速磨钻相比,超声骨刀的应用可显著减少手术时间、术中出血量及住院时间.%Objective To explore the safety and reliability of ultrasonic bone curette in osteotomy and orthopedic surgery for degenerative thoracolumbar kyphoscoliosis. Methods From March 2013 to June 2015,data of 43 patients with degenerative thoracolumbar kyphoscoliosis treated by multilevel Smith-Petersen osteotomy(SPO) with ultrasonic bone curette(n=19) or high-speed drill(n=24) were collected and analyzed retrospectively. The segments,single segment operation time, intraoperative blood loss,postoperative drainage,length of stay,pre- and post-operative Cobb's angle of scoliosis and kyphosis, change of horizontal distance between sagittal plane C7 plumb line and the posterior superior border of the sacrum(SVA), Japanese Orthopaedic Association(JOA) score,improvement rate of JOA score,visual analogue scale(VAS) score and incidence of complications were compared between the 2 groups. Results All the patients were operated successfully. The 2 groups were compared in segments,single segment operation time,intraoperative blood loss,postoperative drainage and length of stay. The outcomes in the ultrasonic bone curette group was superior to those in the high-speed drill group,and the differences were statistically significant(P<0.05). There were no statistical differences in correction rate of kyphosis,scoliosis and SVA between the 2 groups(P>0.05). The postoperative neurological function of the 2 groups were well improved compared to preoperative ones,but there were no statistical differences in improvement rate of JOA score and VAS score between the 2 groups(P > 0.05). No patients suffered from nerve injury and other complications during the operation,but 2 patient in high-speed drill group had cerebrospinal fluid leakage at post-operation. Conclusion The ultrasonic bone curette is safe and effective for degenerative thoracolumbar kyphoscoliosis. Compare with the high-speed drill,the application of ultrasonic bone curette could shorten the operation time,reduce the amount of bleeding and the length of stay.