文章摘要
吴家文,曹勇,黄玉良,段春岳,王德加,陈锦标,仝国强,尹生云.弧度显微剪应用于全椎板切除术治疗多节段胸椎黄韧带骨化的疗效分析.骨科,2019,10(4):297-302
弧度显微剪应用于全椎板切除术治疗多节段胸椎黄韧带骨化的疗效分析
Application of radian microscissors in en bloc laminectomy for the treatment of multilevel thoracic ossification of ligamentum flavum
投稿时间:2019-04-09  
DOI:10.3969/j.issn.1674-8573.2019.04.008
中文关键词: 胸椎  黄韧带骨化  显微剪  全椎板切除术  减压术,外科
英文关键词: Thoracic vertebrae  Ossification of ligamentum flavum  Microscissors  Laminectomy  Decompression, surgical
基金项目:惠州市科技计划(2018Y030)
作者单位E-mail
吴家文 广东省惠州市中心人民医院脊柱外科广东惠州 516001 wujiawen_80@126.com 
曹勇 中南大学湘雅医院脊柱外科长沙 410008  
黄玉良 广东省惠州市中心人民医院脊柱外科广东惠州 516001  
段春岳 中南大学湘雅医院脊柱外科长沙 410008  
王德加 广东省惠州市中心人民医院脊柱外科广东惠州 516001  
陈锦标 广东省惠州市中心人民医院脊柱外科广东惠州 516001  
仝国强 新疆生产建设兵团第五师医院骨科新疆博乐 833400  
尹生云 新疆生产建设兵团第五师医院骨科新疆博乐 833400  
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中文摘要:
      目的 评估弧度显微剪在全椎板切除术治疗多节段胸椎黄韧带骨化症(thoracic ossification of ligamentum flavum, TOLF)并硬膜粘连的临床疗效和安全性。方法 回顾性分析2013年1月至2018年3月惠州市中心人民医院采用全椎板切除术治疗多节段TOLF并硬膜粘连的病人30例,分为尖刀片组(15例)和弧度显微剪组(15例)。记录并比较两组病人的术中出血量、手术时间、围手术期并发症、改良日本骨科协会(Japanese Orthopaedic Association, JOA)评分及其神经功能恢复率。结果 尖刀片组和弧度显微剪组的随访时间分别为(13.2±1.4)个月、(12.8±2.4)个月。尖刀片组的手术时间和术中出血量分别为(261±45) min、(563±201) ml,显著高于弧度显微剪组的(203±38) min、(493±139) ml,组间比较,差异均有统计学意义(t=4.161,P<0.001;t=6.817,P<0.001)。尖刀片组发生脑脊液渗漏6例,弧度显微剪组脑脊液渗漏1例,两组的脑脊液漏发生率比较,差异有统计学意义(χ2=4.658,P=0.031)。两组病人的末次随访JOA评分均较术前显著提高,但两组病人术前JOA、末次随访JOA及神经恢复率比较,差异均无统计学意义。结论 弧度显微剪全椎板切除术治疗多节段TOLF并硬膜粘连是一种安全有效的治疗方式,与尖刀片分离的手术方式相比,缩短了手术时间,减少了术中出血量,降低了脑脊液漏发生率。
英文摘要:
      Objective To evaluate safety and effectiveness of the application of radian microscissors in en bloc laminectomy for the treatment of multilevel thoracic ossification of ligamentum flavum (TOLF). Methods A retrospective analysis was performed on 30 patients with multilevel TOLF and dural adhesion underwent section Cap uncovering en bloc laminectomy surgery from January 2013 to March 2018 in the Huizhou Municipal Central Hospital. The patients were divided into sharp blade group (15 cases) and radian microscissors group (15 cases). Intraoperative bleeding volume, operation time, perioperative complications, improved Japanese Orthopaedic Association (JOA) score and neurological function recovery rate were recorded and compared between the two groups. Results The follow-up time in the sharp blade group and the radian microscissors group was (13.2±1.4) months and (12.8±2.4) months, respectively. The operation time and intraoperative bleeding volume in the sharp blade group were (261±45) min and (563±201) ml, respectively, which were significantly increased as compared with those in the radian microscissors group [(203±38) min and (493±139) ml] (t=4.161, P<0.001; t=6.817, P<0.001). Perioperative complications included early neurological deterioration, wound infection and leakage of cerebrospinal fluid (6 in the sharp blade group and 1 in the radian microscissors group), and incidences of these complications in the sharp blade group was significantly higher than in the radian microscissors group (χ2=4.658, P=0.031). Although final JOA score in both groups significantly increased, differences in preoperative JOA, final JOA and neurological recovery rate between the two groups were not significant. Conclusion Application of radian microscissors in section Cap uncovering en bloc laminectomy surgery for the treatment of multilevel TOLF can effectively achieve neurological functional recovery in patients, with favorable efficacy and safety in reducing both operation time and intraoperative blood loss and the incidence of cerebrospinal fluid leakage compared with the application of sharp blade.
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