超声骨刀辅助后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病的疗效观察

任毅; 张海鸿

doi:10.16766/j.cnki.issn.1674-4152.003450

超声骨刀辅助后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病的疗效观察

doi: 10.16766/j.cnki.issn.1674-4152.003450

任毅,
张海鸿^,

兰州大学第二医院骨科，甘肃兰州 730030

基金项目:

国家自然科学基金项目 31960175

详细信息

通讯作者:
张海鸿，E-mail：18794842967@163.com

中图分类号: R681.55 R687.42
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- 文章访问数: 184
- HTML全文浏览量: 97
- PDF下载量: 17
- 被引次数: 0
出版历程
- 收稿日期: 2023-12-22
- 网络出版日期: 2024-05-29

Efficacy of cervical expansive open-door laminoplasty under ultrasound bone curette in the treatment of multilevel cervical spondylotic myelopathy

REN Yi,
ZHANG Haihong^,

Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu 730030, China

摘要

摘要: 目的探究超声骨刀(UBC)辅助颈椎后路单开门椎管扩大成形术(CEOL)治疗多节段脊髓型颈椎病(MCSM)的疗效。方法选取2021年9月—2022年11月于兰州大学第二医院接受CEOL治疗的90例MCSM患者，依据UBC应用与否分为UBC组(48例)与常规组(42例)。对比2组围手术期指标、疼痛/功能评分及影像学参数变化。结果 UBC组手术时长[(115.00±18.74)min vs. (130.12±23.38)min]、术中失血量[(152.17±27.36)mL vs. (246.39±30.05)mL]及术后引流量[(120.35±21.17)mL vs. (211.06±42.58)mL]均少于常规组(t=3.403、15.568、13.039，P＜0.001)。随术后时间推移，视觉模拟评分(VAS)、颈椎后伸活动度(ROM)、颈椎曲度较术前均下降(P＜0.05)；日本骨科协会(JOA)评分、矢状面轴向距离(SVA)较术前均上升(P＜0.05)；2组各项评分、影像学参数组间、组间与时间交互作用均无统计学意义(P＞0.05)。结论 UBC与咬骨钳辅助CEOL治疗均能减轻MCSM患者疼痛，促使脊髓往后漂移，恢复其神经功能，且对颈椎活动度影响较小；相比咬骨钳，UBC能明显缩短手术时长，减少术中失血及术后引流量，但CEOL对患者颈椎矢状面平衡有一定的影响，临床需注意。
- 多节段脊髓型颈椎病 /
- 超声骨刀 /
- 颈椎后路单开门椎管扩大成形术 /
- 矢状位平衡
Abstract: Objective To explore the efficacy of cervical expansive open-door laminoplasty (CEOL) under ultrasound bone curette (UBC) in the treatment of multilevel cervical spondylotic myelopathy (MCSM). Methods A total of 90 MCSM patients who received CEOL treatment at the Second Hospital of Lanzhou University from September 2021 to November 2022 were collected and divided into UBC group (48 cases) and conventional group (42 cases) according to whether UBC was used or not. Perioperative indexes, pain/function scores and imaging parameters were compared between the two groups. Results The operation duration [(115.00±18.74) min vs. (130.12±23.38) min], intraoperative blood loss [(152.17±27.36) mL vs. (246.39±30.05) mL] and postoperative drainage volume [(120.35±21.17) mL vs. (211.06±42.58) mL] in UBC group were lower than those in conventional group (t=3.403, 15.568, 13.039, P < 0.001). With the passage of time after surgery, visual analogue score (VAS), cervical posterior extension range of motion (ROM) and cervical curvature all showed a decreasing trend (P < 0.05). Japanese Orthopaedic Association (JOA) score, sagittal vertical axis (SVA) and vertebrae-spinal cord posterior margin distance all showed an increasing trend (P < 0.05). Differences in the comparison of all scores and imaging parameters between the two groups and on the interaction between the groups and time were not statistically significant (P>0.05). Conclusion UBC and CEOL assisted with bone rongeur can alleviate pain in MCSM patients, promote spinal cord to drift backward, restore nerve function, and have little effect on cervical motion. Compared with bone rongeur, UBC can significantly shorten the duration of operation, reduce intraoperative blood loss and postoperative drainage flow, but CEOL has a certain impact on the cervical sagittal balance of patients, and clinical attention should be paid to it.
- Multilevel cervical spondylotic myelopathy /
- Ultrasound bone curette /
- Cervical expansive open-door laminoplasty /
- Sagittal equilibrium

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表 1 2组MCSM患者手术相关指标比较(x±s)

Table 1. Comparison of surgery-related indexes in 2 groups of MCSM patients(x±s)

组别	例数	手术时长 (min)	术中失血量 (mL)	术后引流量 (mL)	住院时间 (d)
UBC组	48	115.00±18.74	152.17±27.36	120.35±21.17	7.00±2.00
常规组	42	130.12±23.38	246.39±30.05	211.06±42.58	7.84±2.12
t值		3.403	15.568	13.039	1.933
P值		0.001	＜0.001	＜0.001	0.057

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表 2 2组MCSM患者VAS、JOA评分变化比较(x±s，分)

Table 2. Comparison of VAS and JOA scores in 2 groups of MCSM patients(x±s, points)

组别	例数	VAS评分			F值	P值	JOA评分			F值	P值
组别	例数	术前	术后7 d	术后1年	F值	P值	术前	术后7 d	术后1年	F值	P值
UBC组	48	5.33±0.72	2.00±0.68^a	1.19±0.39^ab	500.091	＜0.001	9.31±1.09	14.21±1.17^a	15.38±1.10^ab	384.830	＜0.001
常规组	42	5.31±0.81	2.17±0.76^a	1.26±0.50^ab	386.442	＜0.001	9.26±1.33	14.05±1.36^a	15.26±0.91^ab	326.803	＜0.001
F值		0.147	1.093	0.791			0.198	0.603	0.525
P值		0.883	0.277	0.431			0.843	0.597	0.601
注：与同组术前比较，^aP＜0.05；与同组术后7 d比较，^bP＜0.05。

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表 3 2组MCSM患者颈椎ROM变化比较(x±s，°)

Table 3. Comparison of cervical ROM changes in 2 groups of MCSM patients(x±s, °)

组别	例数	前屈			F值	P值	后伸			F值	P值
组别	例数	术前	术后3个月	术后1年	F值	P值	术前	术后3个月	术后1年	F值	P值
UBC组	48	49.20±8.44	46.58±7.45	47.26±8.54	1.313	0.274	49.01±10.19	40.26±12.46^a	42.03±9.51^a	9.705	＜0.001
常规组	42	49.12±8.79	45.74±8.47^a	46.02±7.80^a	3.395	0.038	48.95±9.16	38.64±5.36^a	39.58±7.87^a	41.581	＜0.001
F值		0.048	0.500	0.716			0.025	0.907	1.318
P值		0.962	0.618	0.476			0.980	0.367	0.191

组别	例数	左侧屈			F值	P值	右侧屈			F值	P值
组别	例数	术前	术后3个月	术后1年	F值	P值	术前	术后3个月	术后1年	F值	P值
UBC组	48	42.06±13.44	40.57±10.85	40.68±8.74	0.263	0.769	41.68±9.90	37.45±9.66^a	38.20±9.01	2.594	0.080
常规组	42	41.78±9.55	37.90±7.42^a	39.15±5.44	2.387	0.105	41.34±7.00	36.62±6.08^a	37.38±6.62^a	6.699	0.002
F值		0.112	1.345	0.979			0.182	0.479	0.484
P值		0.911	0.182	0.330			0.856	0.633	0.629
注：与同组术前比较，^aP＜0.05。

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表 4 2组MCSM患者矢状位平衡参数及椎体-脊髓后缘距离变化比较(x±s)

Table 4. Comparison of sagittal position balance parameters and spinal-spinal posterior margin distance in 2 groups of MCSM patients(x±s)

组别	例数	C_2~7 Cobb角(°)			F值	P值
组别	例数	术前	术后3个月	术后1年	F值	P值
UBC组	48	16.73±5.56	15.30±3.94	15.54±3.78	0.928	0.403
常规组	42	17.02±5.00	15.13±3.25^a	15.28±2.44	2.702	0.079
F值		0.262	0.220	0.383
P值		0.792	0.826	0.703

组别	例数	颈椎曲度(°)			F值	P值
组别	例数	术前	术后3个月	术后1年	F值	P值
UBC组	48	19.34±5.34	16.18±4.19^a	16.47±3.06^a	10.351	＜0.001
常规组	42	19.28±5.46	16.03±2.65^a	16.25±4.59^a	7.391	0.002
F值		0.051	0.197	0.265
P值		0.959	0.844	0.791

组别	例数	SVA(mm)			F值	P值
组别	例数	术前	术后3个月	术后1年	F值	P值
UBC组	48	17.14±2.72	21.36±3.76^a	21.10±5.46^a	33.959	＜0.001
常规组	42	17.28±4.14	21.43±4.24^a	21.26±3.30^a	15.665	＜0.001
F值		0.191	0.086	0.172
P值		0.849	0.932	0.864

组别	例数	T₁S(°)			F值	P值
组别	例数	术前	术后3个月	术后1年	F值	P值
UBC组	48	26.54±4.81	24.63±3.80^a	25.00±4.61	2.960	0.057
常规组	42	27.01±5.46	24.25±3.67^a	24.87±4.23	4.229	0.018
F值		0.436	0.483	0.142
P值		0.664	0.631	0.888

组别	例数	椎体-脊髓后缘距离(mm)			F值	P值
组别	例数	术前	术后3个月	术后1年	F值	P值
UBC组	48	9.16±1.35	12.27±1.86^a	12.30±2.02^a	101.444	＜0.001
常规组	42	9.20±1.61	12.21±1.31^a	12.24±1.82^a	59.820	＜0.001
F值		0.120	0.177	0.140
P值		0.905	0.860	0.889
注：与同组术前比较，^aP＜0.05。

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