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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:

期数:

2026年01期

页码:

25-30

栏目:

脊柱专题

出版日期:

2026-02-05

文章信息/Info

Title:

Clinical study of hoof-shaped ultrasonic osteotome-assisted posterior cervical expansive open-door laminoplasty for multilevel cervical spondylotic myelopathy

作者:

李亚伟 潘强强 张振辉 周迎超 王金炉 王庆德 梅伟

450000 郑州市骨科医院脊柱骨科 脊髓型颈椎病； 颈椎后路单开门术； 蹄形超声骨刀； 围术期管理； 生物力学

Author(s):

Li Yawei;  Pan Qiangqiang;  Zhang Zhenhui;  Zhou Yingchao;  Wang Jinlu;  Wang Qingde;  Mei Wei.

Department of Spinal Orthopedics, Zhengzhou Orthopedic Hospital, Zhengzhou 450000, China

Keywords:

Cervical spondylotic myelopathy;  Posterior cervical expansive open-door laminoplasty;  Hoof-shaped ultrasonic osteotome;  Perioperative management;  Biomechanics

DOI:

10.3877/cma.j.issn.2096-0263.2026.01.004

文献标志码:

A

摘要:

目的 探讨蹄形超声骨刀辅助下颈后路单开门治疗多节段脊髓型颈椎病的临床应用价值。方法 采用回顾性队列分析2021年1月至2025年3月郑州市骨科医院150例多节段脊髓型颈椎病患者的临床资料，依据术中使用器械分为蹄形超声骨刀组（A组）50例、片状超声骨刀组（B组）48例及高速磨钻组（C组）52例。其中男84例，女66例，平均年龄（53.6±5.4）岁，比较三组术中指标（开门时间、出血量）、术前、术后1周JOA评分及改善率、术后6个月JOA评分、并发症的发生率及门轴骨愈合率。结果 切割效率：A组开门时间最短[（29.8±5.5）min]，显著短于B组[（38.4±7.9）min]及C组[（52.7±9.1）min（P＜0.001）]；术中出血量A组[（78.6±20.6）ml]显著少于B、C组[（105.8±29.1）ml，（134.6±35.7）ml]（P均＜0.001）。三组JOA评分术前、术后1周、术后6个月在重复测量设计的方差分析显示三组组间差异无统计学意义，组别与时间点间无交互作用，各时间点两组差别均无统计学意义；三组组内在各时间点间差异均有统计学意义。安全性：A组C5神经根麻痹为2%（1/50）、B组C5神经根麻痹为2.1%（1/48），C组C5神经根麻痹为3.8%（2/52）（P=0.582），三组差异无统计学意义；A、B组硬膜撕裂率均为0%，而 C组发生4例硬膜撕裂，发生率为7.7%（4/52）（P=0.047）；术后感染及新发颈痛三组间对比无明显差异（P＞0.05）；门轴骨愈合率：A组术后3个月门轴骨愈合率95.2%，显著高于B组（93.8%）及C组（84.6%，P=0.034）。结论 三种器械均能有效开门，但是蹄形超声骨刀相较于片状超声骨刀与高速磨钻具有更高的效率与安全性。

Abstract:

Objective To evaluate the clinical value of a hoof-shaped ultrasonic bone curette in posterior cervical expansive open-door laminoplasty for multilevel cervical spondylotic myelopathy (CSM). Methods A retrospective cohort analysis was conducted on 150 patients with multilevel cervical spondylotic myelopathy treated at Zhengzhou Orthopedic Hospital from January 2021 to March 2025. Patients were divided into three groups based on surgical instruments used: Group A (hoof-shaped ultrasonic osteotome, n=50)?, Group B (flap-shaped ultrasonic osteotome, n=48)?, Group C (high-speed drill, n=52). The cohort included 84 males and 66 females, with a mean age of (53.6±5.4) years. Comparative analysis included intraoperative parameters (laminoplasty time, blood loss), pre- and postoperative 1-week/6-month Japanese Orthopaedic Association (JOA) scores and improvement rates, complication rates, and hinge bone healing rates at 3 months. Results Cutting efficiency?:Group A demonstrated the shortest laminoplasty time [(29.8±5.5) min], significantly shorter than Group B [(38.4±7.9) min] and Group C [(52.7±9.1) min] (P<0.001). Intraoperative blood loss in Group A [(78.6±20.6) ml] was significantly lower than Groups B [(105.8±29.1) ml] and C [(134.6±35.7) ml] (P<0.001). Functional outcomes?: Repeated-measures ANOVA showed no significant differences in JOA scores across groups at any time point, with no group-by-time interaction.Significant intragroup improvements were observed in all groups at each follow-up time point.Safety?: C5 nerve root palsy rates: Group A (2%, 1/50), Group B (2.1%, 1/48), Group C (3.8%, 2/52) (P=0.582). Dural tear rate: 0% in Groups A/B vs. 7.7% in Group C (P=0.047).No significant differences in postoperative infection or new-onset neck pain (P>0.05). Hinge bone healing at 3 months: Group A (95.2%)>Group B (93.8%)>Group C (84.6%) (P=0.034). Conclusion All three instruments effectively performed laminoplasty, but the hoof-shaped ultrasonic osteotome demonstrated superior efficiency and safety compared to flap-shaped ultrasonic osteotomes and high-speed drills.

备注/Memo

备注/Memo:

基金项目：河南省科技攻关项目（242102310205）

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更新日期/Last Update: 2026-05-18