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Title: [Clinical safety and efficiency of ultrasonic bone curette used in anterior cervical discectomy and fusion surgery].
Author: Li YW, Wang HJ, Cui W, Xiao W, Hu BT, Li F.
Journal: Zhonghua Yi Xue Za Zhi; 2020 Mar 10; 100(9):669-673. PubMed ID: 32187909.
Abstract:
Objective: To investigate the safety and efficiency of ultrasonic bone curette used in anterior cervical discectomy and fusion surgery. Methods: As a retrospective study, we collected and analyzed the clinical data of 47 patients receiving anterior cervical discectomy and fusion surgery in Luohe Central Hospital from January 2014 to January 2017, there were 26 males and 21 females with a mean age of (52±9) years. According to the different surgical tools used in the process of decompression by resecting osteophytes or bone like an inverted Chinese character "" located at the posterior margin of the vertebral body, the patients were divided into two groups: ultrasonic bone curette group (group A) and traditional tools group (group B). The operating time, volume of intraoperative blood losing, complications, Japanese Orthopedic Association (JOA) score before and after the operation and improvement rate were recorded in the two groups. The t test was used to compare the data between the two groups. Results: In group A, the operating time was (47±7) min, blood loss was (49±4) ml, 1 case experienced urinary tract infection and there was no cerebrospinal fluid leakage or spinal cord injury. In group B, the operating time was (54±12) min and the blood loss was (117±16) ml, cerebrospinal fluid leakage occurred in 2 patients and the incision healed one-stage by local compression, hoarseness happened in 1 case and it disappeared after 2 weeks, 2 patients had swallowing discomfort and recovered in one month, no spinal cord injury occurred in this group. The operating time and blood loss in group A were lower than those in group B (t=2.691, 20.704, both P<0.05). And the incidence of complications in group A were lower than that in group B (χ(2)=4.157, P=0.041). The JOA score of group A at 3 days after surgery was improved for 39.0% when compared with that before the surgery, and it was improved for 71.6% at one year after the surgery. The JOA score in group B at 3 days after surgery was elevated for 38.7% from that before the surgery, and it increased for 69.4% at one year after the surgery. There was no significant different in JOA score before the surgery, 3 days and one year after the surgery between the two groups (t=0.611, 1.076, 0.061, all P>0.05). Conclusion: In the process of decompression by resecting osteophytes or bone located at the posterior margin of the vertebral body in the anterior cervical discectomy and fusion surgery, ultrasonic bone curette is safe and effective, and it can effectively shorten the operating time, decrease the blood loss and cut down the incidence of complications. 目的： 探讨超声刮匙在颈椎前路椎间盘切除融合术（ACDF）中应用的安全性和有效性。 方法： 回顾性分析2014年1月至2017年1月在漯河市中心医院确诊为脊髓型颈椎病并行ACDF的47例患者资料，其中男26例，女21例，年龄（52±9）岁。在切除椎体后缘骨质和（或）骨赘使椎间隙呈倒八字的减压过程中，根据术中切除工具的不同将患者分为2组：应用超声刮匙切除椎体后缘骨质和（或）骨赘者为A组，应用传统工具（磨钻、刮匙、枪状咬骨钳）的为B组。记录两组患者手术时间、术中出血量、手术并发症、术前及术后日本骨科学会（JOA）脊髓功能评分及改善率。两组间数据比较采用t检验。 结果： A组手术时间（47±7）min，出血量（49±4）ml，B组则分别为（54±12）min和（117±16）ml，A组均低于B组，差异有统计学意义（t=2.691、20.704，均P<0.05）。A组1例出现泌尿系感染，无脑脊液漏及脊髓损伤发生；B组2例出现脑脊液漏，经局部压迫切口一期愈合，1例出现声音嘶哑，2周后消失，2例出现吞咽不适，术后1个月内症状消失，无脊髓损伤发生；A组并发症发生率低于B组（χ(2)=4.157，P=0.041）。A组术后3 d JOA评分较术前改善39.0%，术后1年改善率71.6%；B组术后3 d JOA评分较术前改善38.7%，术后1年改善率69.4%；两组术前、术后3 d及术后1年的JOA评分差异均无统计学意义（t=0.611、1.076、0.061，均P>0.05）。 结论： 在颈椎前路椎间隙内行椎体后缘骨质和（或）骨赘切除减压的过程中，应用超声刮匙安全、有效、快捷，与传统方法相比，可缩短手术时间、减少出血量，并可减少并发症的发生。.

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