摘要
目的 探讨显微入路半椎板手术联合超声骨刀对椎管肿瘤的治疗效果及安全性.方法 选取2019年1月至2024年1月延安大学附属医院收治的80例椎管肿瘤患者展开前瞻性分析.按照随机数字表法将其分为观察组与对照组,各40例.对照组采取传统全椎板手术治疗,观察组采取显微入路半椎板手术联合超声骨刀治疗.观察两组的近期疗效、脊柱稳定性,记录手术时间、术中出血量、首次下床时间及住院时间,比较两组手术后3 d及手术后3个月的炎症因子[白细胞介素(IL)-6、IL-1、肿瘤坏死因子α(TNF-α)]水平、手术后3 d及手术后3个月的腰椎功能[脊柱功能指数量表(SFI)与日本骨科协会(JOA)评分],记录两组患者术后并发症发生情况.结果 观察组患者总有效率与对照组比较,差异无统计学意义(P＞0.05);观察组术后脊柱稳定率为97.50％,高于对照组(85.00％),差异有统计学意义(P＜0.05).观察组手术时间、术中出血量、首次下床时间及住院时间分别为(185.15±10.47)min、(223.82±11.08)mL、(8.12±3.73)d、(21.46±4.14)d,均明显低于对照组[(215.95±11.34)min、(315.35±15.12)mL、(14.85±2.28)d、(33.35±5.54)d],差异均有统计学意义(P＜0.05).手术后3 d,两组患者炎症因子水平均较手术前升高,且观察组 IL-6、IL-1、TNF-α 水平分别为(237.58±9.12)pg/mL、(31.59±3.24)μg/L、(132.41±18.35)pg/mL,均低于对照组[(485.36±23.15)pg/mLA(38.12±3.64)μg/LA(174.06±22.24)pg/mL],差异均有统计学意义(P＜0.05).手术后3个月,两组患者SFI、JOA评分均较手术后3 d升高,且观察组手术后3个月的SFI评分、JOA评分分别为(67.58±11.12)、(20.52±3.31)分,均明显高于对照组[(52.36±9.35)、(15.69±4.24)分],差异均有统计学意义(P＜0.05).观察组总术后并发症发生率为10.00％,显著低于对照组(30.00％),差异有统计学意义(P＜0.05).结论 针对椎管肿瘤患者采取显微入路半椎板手术联合超声骨刀治疗疗效与传统全椎板手术治疗相比疗效并无显著差异,但可提升脊柱稳定性,降低手术损伤,缩短手术时间,促进患者早日康复,而且能够降低患者术后炎症反应水平,改善术后脊柱功能,且安全性较高.
Abstract
Objective To explore the therapeutic effect and safety of microsurgical approach hemilaminectomy combined with ultrasonic bone knife for spinal canal tumors.Methods A prospective analysis was performed on 80 patients with spinal canal tumors admitted to the Affilia-ted Hospital of Yan'an University from January 2019 to January 2024.According to the random number table method,they were divided into the observation group and the control group,40 cases in each group.The control group was treated with traditional total laminectomy,and the observa-tion group was treated with microsurgical approach hemilaminectomy combined with ultrasonic bone knife.The short-term efficacy and spinal sta-bility of the two groups were observed.The operation time,intraoperative blood loss,first time to get out of bed and hospitalization time were recor-ded.The levels of inflammatory factors[interleukin(IL)-6,IL-1,tumor necrosis factor-α(TNF-α)]at 3 days and 3 months after opera-tion,the lumbar function[spinal function index(SFI)and Japanese Orthopaedic Association(JOA)score]at 3 days and 3 months after opera-tion were compared between the two groups.The postoperative complications of the two groups were recorded.Results There was no statistically significant difference in the total effective rate between the observation group and the control group(P＞0.05).The postoperative spinal stability rate of the observation group was 97.50％,which was higher than that of the control group(85.00％),and the difference was statistically signifi-cant(P＜0.05).The operation time,intraoperative blood loss,first time to get out of bed and hospitalization time in the observation group were(185.15±10.47)min,(223.82±11.08)mL,(8.12±3.73)d and(21.46±4.14)d,respectively,which were significantly lower than those in the control group[(215.95±11.34)min,(315.35±15.12)mL,(14.85±2.28)d and(33.35±5.54)d],and the differences were statistically significant(P＜0.05).At three days after operation,the levels of inflammatory factors in the two groups were higher than those before operation,and the levels of IL-6,IL-1 and TNF-α in the observation group were(237.58±9.12)pg/mL,(31.59±3.24)μg/L and(132.41±18.35)pg/mL,respectively,which were lower than those in the control group[(485.36±23.15)pg/mL,(38.12±3.64)μg/L,(174.06±22.24)pg/mL],the differences were statistically significant(P＜0.05).At 3 months after operation,the SFI and JOA scores of the two groups were higher than those at 3 days after operation,and the SFI and JOA scores of the observation group at 3 months after op-eration were(67.58±11.12)and(20.52±3.31)points,respectively,which were significantly higher than those of the control group[(52.36±9.35)and(15.69±4.24)points],the differences were statistically significant(P＜0.05).The total incidence of postoperative complica-tions in the observation group was 10.00％,which was significantly lower than that in the control group(30.00％),and the difference was statis-tically significant(P＜0.05).Conclusion There is no statistically significant difference in the therapeutic effect between microsurgical ap-proach hemilaminectomy combined with ultrasonic bone knife and traditional total laminectomy for patients with spinal canal tumors.However,it can improve spinal stability,reduce surgical damage,shorten surgical time,promote early recovery of patients,reduce postoperative inflammatory response levels,improve postoperative spinal function,and has high safety.
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