| ?objective?To compare the efficacy and safety of ultrasonotomy and high speed drilling in posterior single-door cervical laminectomy and total lumbar laminectomy.?method?A retrospective analysis was performed on 34 patients who underwent cervical open-door surgery in our hospital on January 1,2017,solstice,August 31,2018 and met the inclusion criteria.The lesions involved 3 patients with 3 segments,18 patients with 4 segments,10 patients with 5 segments,and 1 patient with 6 segments.Whether to use ultrasonic osteotome is divided into ultrasonic osteotome group and drilling group.Among them,16 patients(13 males and 3 females,age 59.75±7.51 years old)were in the ultrasonotomy group,with 4.12 ± 0.62 operative segments and preoperative JOA score of 10.19±1.11.There were 18 patients in the grinding and drilling group,including 14 males and 4 females,aged 61.11±7.47 years old,with 4.39±0.70 operative segments,and preoperative JOA score of 10.06±1.17.On August 31,2018,75 patients underwent lumbar total laminectomy in our hospital due to lumbar spinal stenosis and met the inclusion criteria,among which imaging indicated that the lesion involved 31 patients with 1 segment,36 patients with 2 segments,and 8 patients with 3 segments.Whether to use ultrasonic osteotome is divided into ultrasonic osteotome group and drilling group.Among them,31 patients(19 males and 12 females,age 58.87±7.17 years old)were in the ultrasonic osteotomy group,with 1.67±0.6 operative segments and 12.78±1.33 preoperative JOA score.There were 44 patients in the grinding and drilling group,including 26 males and 18 females,aged 59.38 ± 6.60 years old,with 1.70 ± 0.7 operative segments and 12.59±1.67 preoperative JOA score.By comparing the operation time,blood loss,postoperative drainage volume,hospitalization time,postoperative JOA score and JOA score improvement rate and complications of patients in the two groups of cervical or lumbar spine,the efficacy and safety of ultrasonic bone scalpel and drill in spine surgery were compared.?results?Among patients undergoing single-door cervical surgery,there was no significant difference in the operative time and total hospital stay between the ultrasonic osteoptomy group and the high-speed drilling group,in which the intraoperative blood loss was 256.2 ± 134.00 ml in the ultrasonic osteoptomy group,394.4 ±176.48 ml in the drilling group,with a P value of < 0.05.One day after surgery,the drainage flow was 155.63±98.99 ml in the ultrasonic osteoptomy group,and 215.56±56.80 ml in the drilling group,with a P value of < 0.05.The amount of bleeding and the drainage volume on the first day after the operation were significantly lower in the ultrasonic osteotomy group than in the drill group.Among the patients undergoing total laminectomy in the later stage of lumbar spine,there was no significant difference in the operative time and total hospitalization time between the two groups,among which the intraoperative blood loss was 308.06±150.05 ml in the ultrasonic osteotome group,465.90±358.25 ml in the drilling group(P < 0.05),144.52±80.37 ml in the first day of postoperative drainage volume in the ultrasonic osteotome group,and 205.23±77.60 ml in the drilling group(P < 0.05).The amount of bleeding and the drainage volume on the first day after the operation were significantly lower in the ultrasonic osteotomy group than in the drill group.?conclusion?The amount of intraoperative blood loss and postoperative drainage volume were significantly lower than those in the high-speed drilling group,but there were no significant differences between the two groups in operation time,complications and postoperative JOA improvement rate.In the case of reasonable application,both ultrasonic bone scalpel and drill can safely and effectively carry out cervical single-door and lumbar total laminectomy.Compared with drill,ultrasonic bone scalpel has the advantage of less bleeding. |
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