超声骨刀应用于退变性腰椎后凸畸形手术的有效性及安全性

摘要

Objectives:To evaluate the safety and reliability of ultrasonic bone curette on spinal osteotomy in treating degenerative kyphosis.Methods:A retrospective analysis of clinical data of 37 patients with spinal osteotomy from March 2014 to June 2015.Smith-Petersen osteotomy (SPO) was performed in 22 patients with 72 segments,and 15 patients with 19 segments underwent pedicle subtraction osteotomy (PSO).Recording operation time of resection on the articular process,blood loss,perioperative complications such as cerebrospinal fluid leak,injury of nerve root and spinal cord.The improvements of clinical symptoms were analyzed on the 7th day after operation.Results:All patients were operated successfully.In the 22 patients by SPO,the average time for each segment was (4.5±l.8)min (range,2.7 ～6.3min).The average blood loss for each segment was (105.3±49.3)mL (range,50.0 ～ 200.0mL).In the 15 patients by PSO,the blood loss was (535.8±197.0)mL (range,255.0 ～ 800.0mL).No patient injury of nerve root and spinal cord,2 cases cerebrospinal fluid leak.36 patients symptom remission but one patients experienced unilateral foot drop which was cured by conservative treatment.On the last follow-up,37 cases with back and leg pain were in remission.Conclusions:The ultrasonic bone curette was safety and effective.When it was used in extremely stenosis segment,nerve root injury is not uncommon,which can be avoided by cautioning the cutting time of the ultrasonic bone curette.%目的:探讨超声骨刀在退变性腰椎后凸畸形手术应用中的有效性及安全性.方法:回顾性分析自2014年3月至2015年6月在长征医院确诊为腰椎退变性后凸畸形且术中采用超声骨刀行经椎弓根椎体截骨(pedicle subtraction osteotomy,PSO)或行多节段经关节突截骨(Smith-Petersen osteotomy,SPO)的37例患者临床资料.其中行SPO22例,共计切除腰椎关节突关节72个节段;行PSO15例,共计对19个节段腰椎截骨.记录关节突关节切除时间、术中有无神经根损伤、有无硬膜损伤和脑脊液漏、术中出血量;术后1周评估患者症状改善情况,随访半年.结果:37例患者手术均顺利完成,22例SPO患者单个节段腰椎关节突关节切除时间为(4.5±1.8) min (2.7 ～ 6.3min),单个节段腰椎关节突关节切除术中出血量为(105.3±49.3) mL(50.0 ～ 200.0mL);行PSO的15例患者术中出血量为(535.8±197) mL(255.0 ～ 800.0mL).无神经根、硬膜损伤,2例脑脊液漏;术后1周37例患者中的36例症状均有不同程度改善,1例患者出现左足下垂,但术中未发现神经根切割伤,保守治疗半年后好转.术后末次随访37例患者的腰背部及下肢疼痛均有不同程度改善.结论:应用超声骨刀可以安全、有效地完成退变性腰椎后凸畸形的截骨矫形手术.在退变严重,解剖结构变异导致的椎管及侧隐窝严重狭窄的节段,有加重患者神经症状的风险,但可以通过持续移动刀头,减少在同一部位操作的时间来避免.