超声骨刀后路颈椎扩张开门椎板成形术治疗颈椎退行性疾病的疗效和安全性:一项前瞻性随机对照试验。

IF 1.6 4区 医学
Journal of Orthopaedic Surgery Pub Date : 2025-09-01 Epub Date: 2025-09-26 DOI:10.1177/10225536251364200
Hongzi Wu, Pin Feng, Yongqi Li, Yi Liao, Shaobo Wang
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引用次数: 0

摘要

背景:在颈椎后路开放式椎板成形术(CEOL)中使用的关键器械,如高速钻头(HSD)和超声骨刀(UBS),是根据外科医生的喜好来选择的。然而,一些外科医生仍然对HSD优于广泛使用的UBS持怀疑态度,需要对其实际用途进行科学评估。目的通过一项前瞻性随机对照试验,比较超声骨刀与高速钻头在颈椎后路开开门颈椎椎板成形术中的疗效和安全性。这项前瞻性研究是在获得事先知情同意后进行的,纳入了40名诊断为颈椎退行性疾病的患者,这些患者在2018年7月至2021年6月期间接受了颈椎扩张开门椎板成形术。患者随机分为两组:超声骨手术刀组(n = 20)和高速钻头组(n = 20)。由于干预的性质,外科医生不能盲化,但结果评估者在可行的情况下对组分配进行盲化。比较两组手术时间、开门时间、术中出血量、术后引流损失、术后并发症及功能结局。结果两组在术中出血量、术后并发症、螺钉移位、钢板骨折、脊髓扩张等方面均无统计学差异。超声骨手术刀组手术时间、开门时间、术后引流损失均明显短于高速钻孔组(p < 0.05)。引流量的减少可能是由于UBS对小血管的热密封,而不仅仅是减少了组织损伤。两组术后1周、3个月和1年的视觉模拟评分(VAS)评分、铰链处骨愈合或日本骨科协会(JOA)评分改进率均无显著差异。虽然UBS组在并发症发生率上显示出数值上的降低(例如,硬脑膜撕裂:0% vs 5%, p = .311),但这些差异没有达到统计学意义,可能是由于样本量有限。结论USB可显著减少手术时间、开门时间和术后引流损失。然而,该研究有限的样本量可能不足以检测组间并发症发生率的差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Efficacy and safety of ultrasonic bone scalpel in posterior cervical expansive open-door laminoplasty for cervical degenerative diseases: A prospective randomized controlled trial.

BackgroundKey instruments used in posterior cervical expansive open-door laminoplasty (CEOL), such as the high-speed drill (HSD) and the ultrasonic bone scalpel (UBS), are selected based on surgeon preference. However, skepticism remains among some surgeons regarding the superiority of the HSD over the widely used UBS, necessitating a scientific evaluation of its practical utility.ObjectiveTo evaluate the efficacy and safety of the ultrasonic bone scalpel compared to the high-speed drill in cervical expansive open-door laminoplasty using a posterior cervical approach in a prospective randomized controlled trial.MethodsThis prospective study, conducted after obtaining prior informed consent, involved 40 patients diagnosed with cervical degenerative diseases who underwent cervical expansive open-door laminoplasty between July 2018 and June 2021. The patients were randomly divided into two groups: the ultrasonic bone scalpel group (n = 20) and the high-speed drill group (n = 20). Surgeons could not be blinded due to the nature of the intervention, but outcome assessors were blinded to group allocation where feasible. Surgical time, open-door time, intraoperative blood loss, postoperative drainage loss, post-operative complications, and functional outcomes were compared between the two groups.ResultsNo statistically significant difference was observed between the two groups in terms of intraoperative blood loss, post-operative complications, screw migration, plate fracture, or spinal cord expansion. However, the ultrasonic bone scalpel group demonstrated significantly shorter surgical time, open-door time, and reduced postoperative drainage loss compared to the high-speed drill group (p < .05). The reduced drainage volume may be attributed to thermal sealing of small vessels by the UBS rather than solely reduced tissue trauma. No significant differences were observed in the Visual Analog Scale (VAS) scores, bony union at the hinge, or Japanese Orthopedic Association (JOA) score improvement rates between the two groups at 1 week, 3 months, and 1 year postoperatively. While the UBS group showed numerical reductions in complication rates (e.g., dural tear: 0% vs 5%, p = .311), these differences did not reach statistical significance, likely due to the limited sample size.ConclusionsThe study concluded that USB significantly reduces operation time, open-door time, and postoperative drainage loss. However, the study's limited sample size may have been insufficient to detect differences in complication rates between groups.

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来源期刊
自引率
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发文量
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期刊介绍: Journal of Orthopaedic Surgery is an open access peer-reviewed journal publishing original reviews and research articles on all aspects of orthopaedic surgery. It is the official journal of the Asia Pacific Orthopaedic Association. The journal welcomes and will publish materials of a diverse nature, from basic science research to clinical trials and surgical techniques. The journal encourages contributions from all parts of the world, but special emphasis is given to research of particular relevance to the Asia Pacific region.
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