超音波骨メス併用による脊椎後方固定術の臨床検討 [in Japanese] Clinical experience of cervical osteoplastic laminotomy with or without scalpel ultrasonic osteotomy with piezoelectric microvibration [in Japanese]
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<i>Introduction</i> : The cavitron ultrasonic surgical aspirator (CUSA<sup>®</sup>)is often used for brain tumor surgery. This tool is capable of cutting bone if the CUSA handpiece is exchanged for a scratch-type bone scalpel handpiece (SONOPEr<sup>®</sup> with scalpel handpiece, M&M Co.) with piezoelectric microvibration. Recently, ultrasonic osteotomy has been widely used in orofacial surgery. spinal surgery. and neurosurgical microsurgery. Therefore, clinical studies of ultrasonic osteotomy using the bone scalpel are required. The aim of this study was to evaluate the effectiveness of ultrasonic scalpel osteotomy by comparing postoperative outcomes. surgical complications. and long—term outcome of osteoplastic laminotomy (OL) over a 3-year period using ultrasonic scalpel osteotomy versus conventional drill surgery (low-speed drill. 8000 rpm, 3M Zimmer).<br><i>Materials & Methods</i> : We compared retrospectively the outcome between an ultrasonic scalpel osteotomy group (S) and a non-use group (N) in patients who underwent cervical 0L between 1998 and 2003 performed by a single surgeon at our hospital. The evaluated items were operation duration. blood loss, hospital stay, complications. neuroimaging findings, neurological outcome, and 3-year outcome in terms of the Kamofsky scale.<br><i>Results</i> : The amount of bleeding was significantly lower in the S group (218.3±63.7 ml vs 766.9±572.4 ml; P<0.009), but there was no significant intergroup difference in operation time, hospitalization or spinal canal enlargement revealed by neuroimaging. Neurological outcome and 3-year outcome on the Kamofsky scale showed the same trend. There was no incidence of dural injury. nerve injury. or aspiration-related accident.<br><i>Conclusions</i> : Use of ultrasonic osteotomy using the piezoelectric effect may reduce the amount of bleeding in patients undergoing OL, and tends to facilitate more accurate laminoplasty and shorter hospitalization. This technique is equivalent to drill surgery in terms of operation time, postoperative outcome. and long-term outcome.
Neurosonalogy 20(2), 105-109, 2007-12-30
The Japan Academy of Neurosonology