单开门颈椎管扩大成形侧块螺钉结合棘突椎板螺钉内固定治疗颈椎管狭窄症

Open-door expansive laminoplasty using lateral mass screw combined spinous process laminar screw fixation for the treatment of cervical spinal stenosis

目的探讨单开门颈椎管扩大成形侧块螺钉结合棘突椎板螺钉内固定治疗颈椎管狭窄症的临床疗效。方法采用单开门颈椎管扩大成形侧块螺钉结合棘突椎板螺钉内固定治疗25例颈椎管狭窄症患者。以JOA评分(17分法)及其改善率评价术后神经功能改善情况;影像学检查评价椎管扩大和维持情况及门轴侧骨融合情况。结果手术时间为(120±25)min;术中出血量为(675±105)ml。术后1例出现C5神经根麻痹,经3周保守治疗症状逐渐消失。25例均获随访,时间6～24个月。JOA评分术前为(9.4±1.0)分,术后6个月为(14.6±1.3)分,JOA改善率为(68.2±9.2)%。X线片及CT示椎管扩大满意,门轴侧均骨性愈合,均未见椎板塌陷和再关门现象。C5节段椎管矢状径术前为(9.2±1.0)mm,术后6个月为(14.5±1.2)mm,椎管扩大率为(57.6±13.8)%。结论单开门颈椎管扩大成形侧块螺钉结合棘突椎板螺钉内固定治疗颈椎管狭窄症是一种安全有效的手术方法,在抬起椎板获得即刻稳定的同时,可以恢复椎管的完整性。

Objective To explore the clinical efficacy of open-door expansive laminoplasty using lateral mass screw combined spinous process laminar screw fixation for cervical spinal stenosis.Methods 25 cases with cervical spinal stenosis were treated surgically by open-door expansive laminoplasty using lateral mass screw combined spinous process laminar screw fixation.The neurofunction was evaluated by Japan Orthopaedic Association(JOA) score;X-ray and CT were used to evaluate postoperative spinal canal enlargement and bone fusion at the hinge side.Results The average operation time was(120±25)min;the average intraoperative blood loss was(675±105)ml.C5 palsy was noted in 1 case after operation,which was resolved gradually after 3 weeks of correspondent intervention.All patients were followed up for 6-24 months.The average JOA score for preoperation was(9.4±1.0) and(14.6±1.3) at 6 months after operation,which the improvement rate of(68.2±9.2)%.Radiographic findings showed spinal canal enlarged perfectly,with bony fusion at hinge side and without recurrence of cervical stenosis.The mean sagittal diameter of C5 spinal canal was(9.2±1.0) mm before operation and(14.5±1.2)mm at 6 months after operation,with the expansion rate of(57.6±13.8)%.Conclusions Open-door expansive laminoplasty using lateral mass screw combined spinous process laminar screw fixation for cervical spinal stenosis is a safe and effective treatment.The integrity of spinal canal is recovered,in the time of initial instability of the elevated laminae.