超声骨刀用于中老年腰椎管狭窄行PLIF术的效果和安全性评价

葛灵 秦璟灏 仇胥斌 张建伟

[摘要] 目的 探討用超声骨刀行后路腰椎椎体间融合术（PLIF）治疗中老年腰椎管狭窄的疗效及安全性。 方法 选取2018年3月至2020年6月间符合腰椎管狭窄的中老年患者102例，通过随机法将患者纳入对照组与试验组各51例，对照组采取常规手术方式切除椎板，试验组通过超声骨刀切除椎板。通过两组椎板切除时间、术中出血量、术后引流量、住院时间、视觉模拟评分法（VAS）及日本骨科协会评估治疗分数（JOA）对临床疗效评价;通过比较各组治疗后各并发症发生率对其安全性进行评估。 结果 两组患者年龄、症状持续时间、体重指数比较，差异无统计学意义（P>0.05）;试验组椎板切除时间、术中出血量、术后引流量均显著低于对照组（P<0.05）;此外，两组患者在术后VAS评分显著降低，同时JOA评分显著增高（P<0.05），与对照组比较，术后VAS评分下降及JOA评分增高更为显著（P<0.05）。两组术后并发症总发生率比较，差异有统计学意义（P<0.05）。 结论 用超声骨刀行PLIF治疗中老年腰椎管狭窄可显著提升患者术后功能恢复，并发症发生率更低，值得在临床推广。

[关键词] 超声骨刀;路腰椎椎体间融合术;临床疗效;安全性

[中图分类号] R687.3          [文献标识码] B          [文章编号] 1673-9701（2021）31-0102-04

[Abstract] Objective To investigate the efficacy and safety of lumbar posterior lumbar interbody fusion （PLIF） with ultrasonic bone knife in the treatment of lumbar spinal stenosis in middle-aged and elderly patients. Methods A total of 102 middle-aged and elderly patients with lumbar spinal stenosis from March 2018 to June 2020 were selected， and 51 patients were included in the control group and the experimental group by the random method. The lamina was removed by conventional surgery in the control group， and the lamina was removed by ultrasonic bone knife in the experimental group. The laminectomy time， intraoperative blood losses， postoperative drainage volumes， lengths of hospital stay， Visual Analogue Scores （VAS） and Japanese Orthopaedic Association Scores （JOA） were measured of the two surgical methods were used to evaluate clinical efficacy and outcomes. The safety was evaluated by comparing the incidences of complications in each group after treatment. Results No significant differences were observed in the age， symptom duration and body mass index between the two groups（P>0.05）. The laminectomy time， intraoperative blood loss and postoperative drainage volume in the experimental group were significantly lower than those in the control group （P<0.05）. In addition， the postoperative VAS scores in the 2 groups were significantly decreased， while JOA scores were significantly increased （P<0.05）. Compared with the control group， in the experimental group， postoperative VAS scores were decreased and JOA scores were increased more significantly （P<0.05）. The total incidence of complications between the two groups was statistically significant（P<0.05）. Conclusion PLIF for the treatment of middle-aged and elderly patients with lumbar spinal stenosis can significantly improve the postoperative functional recovery， and the incidence of complications is lower， which is worthy of clinical promotion.

[Key words] Ultrasonic bone knife; Posterior lumbar interbody fusion; Clinical efficacy; Safety

腰椎管狭窄指各种形式引起的腰椎管容积减少或硬膜囊自身狭窄等导致腰腿痛及神经系统症状出现的疾病[1]，常需要手术进行干预治疗。传统手术方式常规使用骨刀、椎板咬骨钳等器械行椎板切除，但切除的椎板形状不规则且边缘粗糙，导致椎板取出時滑破硬膜囊，从而使出血量上升，同时更大可能性损伤神经，引起并发症发生率的上升[2-3]。……