摘要
目的探讨超声骨刀与高速磨钻在颈椎后路单开门椎管成形术中的应用价值。方法回顾性收集沁阳市人民医院2022年1月至2024年12月63例[其中男36例、女27例, 年龄34~68岁, 平均(54.69±6.03)岁]行颈椎后路单开门椎管成形术患者的病历资料, 根据术中骨组织处理器械不同分为对照组和研究组, 对照组31例选择高速磨钻处理骨组织, 研究组32例选择超声骨刀处理骨组织, 比较两组临床疗效、手术相关指标、氧化应激指标、颈椎功能差异。组间比较采用独立样本t检验;计数资料以百分比(%)表示, 组间比较采用χ^(2)检验或Fisher精确检验。结果两组临床疗效比较, 差异无统计学意义[75.00%(24/32)比80.65%(25/31)χ^(2)=0.290, P>0.05];研究组手术及住院时间短于对照组[(150.48±30.66) min比(171.85±34.81) min、(6.32±1.58) d比(7.86±1.84) d, t=2.588、3.568, P<0.05], 术中出血量、术后引流量、C5神经根麻痹发生率低于对照组[(189.04±38.97) ml比(224.69±41.52) ml、(164.85±37.91) ml比(238.55±94.37) ml、3.23%(1/32)比19.35%(6/31), t=3.515、4.091, χ^(2)=4.199, P<0.05];研究组术后1 d晚期蛋白氧化产物(AOPP)低于对照组[(34.67±5.61) μmol/L比(51.09±7.36) μmol/L, t=9.979, P<0.05], 总抗氧化能力(TAOC)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GPx)高于对照组[(7.38±1.41) U/ml比(6.15±1.19) U/ml、(11.60±2.19) U/ml比(9.64±1.38) U/ml、(1.52±0.28) U/ml比(0.83±0.21) U/ml, t=3.736、4.234、11.038, P<0.05];两组术后3个月颈椎功能障碍指数(NDI)、椎体活动度(ROM)、颈椎曲度指数(CCI)比较, 差异无统计学意义[(23.48±3.97)分比(23.60±4.05)分、(22.85±2.63)°比(22.83±2.60)°、(9.59±1.35)%比(9.63±1.37)%, t=0.119、0.030、0.117, P>0.05]。结论超声骨刀与高速磨钻在颈椎后路单开门椎管成形术中疗效相当, 但前者可减轻手术创伤, 缩短术后恢复时间, 降低C5神经根麻痹发生率及术后应激反应。
Objective To explore the application of ultrasonic bone scalpel versus high-speed grinding drill in posterior cervical single-door spinal canal plasty.Methods The medical records of 63 patients[including 36 males and 27 females,aged 34 to 68 years,with an average age of(54.69±6.03)years]who underwent posterior single-door spinal canal plasty in Qinyang People’s Hospital from January 2022 to December 2024 were retrospectively collected.They were divided into the control group and the study group.In the control group,31 cases were given high-speed grinding drill for bone tissue processing,and in the study group,32 cases underwent ultrasonic bone knife for bone tissue processing.The differences in clinical efficacy,surgery-related indicators,oxidative stress indicators and cervical spine function between the two groups were compared.Measurement data conforming to the normal distribution were expressed as(±s),and the independent sample t-test was used for comparison between groups.Count data were expressed as the percentage(%).Comparisons between groups were conducted using the chi-square test or Fisher’s exact test.Results There was no statistically significant difference in the clinical efficacy between the two groups[75.00%(24/32)vs.80.65%(25/31)χ^(2)=0.290,P>0.05].The operative time and hospital stay in the study group were shorter than those in the control group[(150.48±30.66)min vs.(171.85±34.81)min,(6.32±1.58)d vs.(7.86±1.84)d,t=2.588,3.568,P<0.05].The intraoperative blood loss,postoperative drainage volume,and the incidence of C5 nerve root palsy were lower than those in the control group[(189.04±38.97)ml vs.(224.69±41.52)ml,(164.85±37.91)ml vs.(238.55±94.37)ml,3.23%(1/32)vs.19.35%(6/31)][t=3.515,4.091,χ^(2)=4.199,P<0.05].One day after the operation,the advanced oxidation protein product(AOPP)in the study group was lower than that in the control group[(34.67±5.61)μmol/L vs.(51.09±7.36)μmol/L,t=9.979,P<0.05].Total antioxidant capacity(TAOC),catalase(CAT),and glutathione peroxidase(GPx)in the study group were higher than those in the control group[(7.38±1.41)U/ml vs.(6.15±1.19)U/ml,(11.60±2.19)U/ml vs.(9.64±1.38)U/ml,(1.52±0.28)U/ml vs.(0.83±0.21)U/ml,t=3.736,4.234,11.038,P<0.05].There were no significant differences in neck disability index(NDI),range of motion(ROM),and cervical curvature index(CCI)between the two groups 3 months after surgery[(23.48±3.97)points vs.(23.60±4.05)points,(22.85±2.63)°vs.(22.83±2.60)°,(9.59±1.35)%vs.(9.63±1.37)%,t=0.119,0.030,0.117,P>0.05].Conclusion The therapeutic effects of ultrasonic bone scalpel and high-speed grinding drill in posterior cervical single-door spinal canal plasty are comparable.However,the former can reduce surgical trauma,shorten postoperative recovery time,lower the incidence of C5 nerve root palsy and postoperative stress response.
作者
王黎明
丁联
刘宇光
Wang Liming;Ding Lian;Liu Yuguang(Department of Orthopedics,Qinyang People’s Hospital,Qinyang 454500,China)
出处
《中华实验外科杂志》
2026年第1期154-158,共5页
Chinese Journal of Experimental Surgery
关键词
颈椎后路单开门椎管成形术
超声骨刀
高速磨钻
C5神经根麻痹
Posterior cervical single-door spinal canal plasty
Ultrasonic bone knife
High-speed grinding drill
C5 nerve root palsy
