[1]孔亮 邢伟鹏 李薏 刘永辉 韩志 杨磊 曹向阳 崔宏勋△.超声骨刀与传统椎板切开器械应用于脊柱后路手术的有效性与安全性的Meta分析[J].中国中医骨伤科杂志,2019,27(12):42-47.
　KONG Liang XING Weipeng LI Yi LIU Yonghui HAN Zhi YANG Lei CAO Xiangyang CUI Hongxun.Meta-analysis of the Effectiveness and Safety of Ultrasonic Osteotome and Traditional Laminectomy in the Treatment of Posterior Spinal Surgery[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2019,27(12):42-47.
点击复制

超声骨刀与传统椎板切开器械应用于脊柱后路手术的有效性与安全性的Meta分析()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第27卷
期数:
2019年12期
页码:
42-47
栏目:
文献研究
出版日期:
2019-12-04

文章信息/Info

Title:
Meta-analysis of the Effectiveness and Safety of Ultrasonic Osteotome and Traditional Laminectomy in the Treatment of Posterior Spinal Surgery
文章编号:
1005-0205(2019)12-0042-06
作者:
孔亮1 邢伟鹏2 李薏1 刘永辉3 韩志2 杨磊2 曹向阳2 崔宏勋2△
1湖南中医药大学(长沙,410208) 2河南省洛阳正骨医院(河南省骨科医院) 3河南中医药大学
Author(s):
KONG Liang1 XING Weipeng2 LI Yi1 LIU Yonghui3 HAN Zhi2 YANG Lei2 CAO Xiangyang2 CUI Hongxun2△
1Hunan University of Traditional Chinese Medicine,Changsha 410208,China; 2Luoyang Orthopedic Hospital of Henan Province(Orthopedic Hospital of Henan Province),Luoyang 450000,Henan China; 3Henan University of Chinese Medicine,Zhengzhou 450046,China.
关键词:
超声骨刀;  气动磨钻;  咬骨钳;  椎板切除;  Meta分析
Keywords:
ultrasonic osteotome;  high-speed-drill;  laminectomy punch;  laminectomy;  meta-analysis
分类号:
R681.5
文献标志码:
A
摘要:
目的:使用Meta分析方法评价超声骨刀与传统椎板切开器械(椎板咬骨钳、气动磨钻)在脊柱后路手术中的有效性与安全性。方法:以“超声骨刀”“超声手术刀”“超声刀”“椎”为中文关键词,以“ bone curette”“cutter”“scalpel”“bone shaver”“aspirator”“osteotome”“ultrasonic”“piezosurgery”“dent*”为英文检索词,在Pubmed(1966-2018.12),Cochrane Library,Embase(1986-2018.12)、中国生物医学文摘数据库(CBM,1978-2018.12)、中国期刊全文数据库(CNKI,1979-2018.12)、万方数据库(1998-2018.12)、维普数据库(VIP,1989-2018.12)中进行检索,搜集所有使用超声骨刀、气动磨钻和椎板咬骨钳的随机对照试验和队列研究。由2名研究者分别筛选文献并严格地进行数据提取和评价纳入研究质量。Meta分析采用Revman v5.3.5.0版本。结果:经过筛选,最终纳入3项随机对照试验和6项回顾性队列研究,共计548例患者。Meta分析结果显示:采用超声骨刀的试验组的单椎板切除时间(MD=3.20,95%CI(1.16,5.24),P<0.05)、单椎板出血量(MD=26.87,95%CI(11.96,41.77),P<0.01)明显低于采用传统器械(椎板咬骨钳、气动磨钻)的对照组; 但术后JOA评分(MD=-0.13,95%CI(-0.33,0.06),P>0.05)以及并发症发生率(OR=1.57,95%CI(0.68,3.63),P>0.05)的差异无统计学意义。结论:根据既往研究数据,在脊柱后路手术中应用超声骨刀可有效缩短椎板切除时间并有利于止血,减少术中出血量,但在手术疗效、术后恢复、并发症发生率等方面没有显著差异。
Abstract:
Objective:To evaluate the effectiveness and safety of ultrasonic osteotome and traditional laminectomy instruments(high-speed-drill laminectomy punch)in posterior rspinal surgery.Methods:“Ultrasonic bone knife”“ultrasonic scalpel”“ultrasonic scalpel”“vertebra” as Chinese keywords,“bone curette”“cut”“scalpel”“bone shaver”“aspirator”“osteotome”“ultrasonic”“piezosurgery”“dent*” are English search terms,in Pubmed(1966-2018.12),Cochrane Library,Embase(1986-2018.12),Chinese Biomedical Abstracts Database(CBM,1978-2018.12)Search in Chinese Journal Full-text Database(CNKI,1979-2018.12),Wanfang Database(1998-2018.12),and Weipu Database(VIP,1989-2018.12),collect all bone osteo synthesis,pneumatic grinding drill and laminar bone randomized controlled trials and cohort studies of forceps.Two investigators screened the literature separately and rigorously extracted the data and evaluated the quality of the included studies Meta analysis was performed using Revman v5.3.5.0.Results:Three randomized controlled trials and six cohort studies were included with a total of 548 patients.Meta-analysis results showed that the single lami ectomytime of the experimental group using the ultrasonic osteotome(MD=2.70,95%CI(0.32,5.09),P<0.05)single lamina rhemorrhage(MD=26.87,95%CI(11.96,41.77),P<0.01)was significantly lower than the control group using traditional instruments(laminarrongeur.pneumatic grinding); but post operative JOA score(MD=-0.13,95%CI(-0.33,0.06)),P>0.05)and the complication rate(OR=1.57,95%CI(0.68,3.63),P>0.05)was not statistically significant.Conclusion:The available evidence indicates that the use of ultrasonic osteotome in posterior rspinal surgery can effectively shorten the time of laminectomy and reduce the amount of intraoperative blood loss,but there is no significant difference in surgical outcome postoperative recovery,and complication rate.

参考文献/References:

[1] 系统评价/Meta分析报告指南(PRISMA 2009年版)流程图[J].中国胸心血管外科临床杂志,2014,21(1):16. [2] HIGGINS J P T,GREEN S.Cochrane handbook for systematic reviews of interventions version 5.1.0[EB/ OL][2018-08-19].http:/ /www.cochrane handbook.org. [3] STANG A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J].European Journal of Epidemiology,2010,25(9):603-605. [4] ONEN M R,YUVRUK E,AKAY S,et al.The reliability of the ultrasonic bone scalpel in cervical spondylotic myelopathy:a comparative study of 46 patients[J].World neurosurgery,2015,84(6):1962-1967. [5] 刘学光,付强,孙振中,等.超声骨刀与高速磨钻在颈椎后路全椎板切除减压手术应用中的比较研究[J].中国脊柱脊髓杂志,2017,27(6):539-544. [6] 周兴华,杨敏,李涛,等.超声骨刀与咬骨钳在颈椎后路单开门术中应用效果比较[J].临床骨科杂志,2018,21(1):11-13. [7] 曹云,徐剑峰,卿培东,等.超声骨刀在颈后路全椎板切除减压手术中的临床应用[J].颈腰痛杂志,2018,39(6):768-770. [8] 李长宽,孙翊夫,胡艳龙,等.应用超声骨刀与气动磨钻行椎板切除减压治疗胸椎黄韧带骨化症的疗效比较[J].骨科临床与研究杂志,2018,3(5):270-275. [9] 杨鹏,温冰涛,金开基,等.应用超声骨刀行腰椎后路椎板切除术与传统手术技术的对比研究[J].中国脊柱脊髓杂志,2017,27(8):699-703. [10] 汪凡栋.超声骨刀与高速磨钻在颈椎后纵韧带骨化伴椎管狭窄症行颈后路全椎板切除减压手术中的作用对比[J].颈腰痛杂志,2018,39(6):800-802. [11] 潘显纬,张浩,王建喜,等.超声骨刀在治疗黄韧带骨化型胸椎管狭窄症中的应用[J].颈腰痛杂志,2017,38(2):101-105. [12] 王齐超,王海蛟,何兵,等.超声骨刀在颈椎椎板单开门椎管扩大成形术中的应用[J].中国骨与关节损伤杂志,2016,31(11):1121-1123. [13] FREDERICK M,JAMES H.CAMPBELL's operative orthopaedics[M].13th Edition.Singapore:Elsevier,2018:1572-1577. [14] 李玉伟,王海蛟,王玉记,等.后路单开门与一期前后路手术减压治疗前后受压脊髓型颈椎病的疗效比较[J].中国脊柱脊髓杂志,2010,20(3):197-200. [15] ITO K,ISHIZAKA S,SASAKI T,et al.Safe and minimally invasive laminoplastic laminotomy using an ultrasonic bone curette for spinal surgery:technical note[J].Surgical Neurology,2009,72(5):470-475. [16] 中华医学会骨科学分会脊柱外科学组.胸椎管狭窄症诊疗指南[J].中华骨科杂志,2015,35(1):1-5. [17] SASAKI M,MORRIS S,GOTO T,et al.Spray-irrigation system attached to high-speed drills for simultaneous prevention of local heating and preservation of a clear operative field in spinal surgery[J].Neurol Med Chir,2010,50(10):900-904. [18] 陈颖,罗晓宁,史文勇,等.超声手术刀的研制现状与应用[J].生物医学工程学杂志,2005,22(2):377-380. [19] ZHOU Y,GAO X W.Effect of hydrodynamic cavitation in the tissue erosion by pulsed high-intensity focused ultrasound(pHIFU)[J].Physics in Medicine and Biology,2016,61(18):6651-6667. [20] SANBORN M R,BALZER J,GERSZTEN P C,et al.Safety and efficacy of a novel ultrasonic osteotome device in an ovine model[J].Journal of Clinical Neuroscience,2011,18(11):1530-1533. [21] 李玉伟,王海蛟,崔巍,等.超声骨刀在颈椎后路单开门椎管扩大成形术中的应用[J].中国修复重建外科杂志,2017,31(6):683-689. [22] 郑羽晨,张睿,陈晓生,等.超声骨刀在颈椎后路单开门术中的应用[J].深圳中西医结合杂志,2018,28(20):80-83. [23] NAKASE H,MATSUDA R,SHIN Y,et al.The use of ultrasonic bone curettes in spinal surgery[J].Acta Neurochir(Wien),2006,148(2):207-212. [24] Al-MAHFOUDH R,QATTAN E,ELLENBOGEN J R,et al.Applications of the ultrasonic bone cutter in spinal surgery-our preliminary experience[J].British Journal of Neurosurgery,2014,28(1):56-60. [25] 王岩,陈仲强,孙垂国.超声骨刀在胸椎管狭窄症手术中应用的有效性与安全性[J].中国脊柱脊髓杂志,2015,25(6):518-523.

备注/Memo

备注/Memo:
基金项目:河南省科技攻关项目(162102310062) 河南省中医药科学研究专项(2018ZYZD02)△通信作者 E-mail:chx6542@126.com(收稿日期:2019-07-02)
更新日期/Last Update: 2019-12-04