单侧短节段侧块内固定系统在颈椎病单开门减压术中的应用

The clinic significance of the short-segmental fixation after posterior route unilateral open-door laminoplasty in cervical spondylotic myelopathy

目的评估单侧短节段侧块内固定系统在脊髓型颈椎病后路单开门减压椎管扩大成形术中的应用价值。方法回顾分析近6年应用此方法治疗脊髓型颈椎病56例,根据手术前后JOA评分;影像改变评价手术的优缺点。结果56例患者均为脊髓型颈椎病,病变范围均大于3个节段。所有患者均在全麻下接受手术治疗,手术采用经后路单开门减压术式,开门范围C3-7,同时行门轴侧短节段侧块系统内固定(C4-6)植骨融合术。术后平均随访32个月,JOA评分由术前9.2提高到14.6分,优良率为78%。结论后路单开门减压椎管扩大成形术是一种安全有效的治疗脊髓型颈椎病的手术方法,应用单侧短节段侧块内固定系统能增加手术的安全性及疗效。此术式有以下优点:1.通过预弯的内固定系统能很好的维持颈椎生理前凸。2.侧块内固定增加了脊柱稳定性,相对稳定的力学环境利于植骨的融合,缩短患者下床活动及颈部外固定时间。3.掀开的椎板帘通过粗丝线结扎固定于钉杆上,增加了固定强度,避免了再关门现象。4.单侧短节段侧块内固定属限制性固定,既解决了稳定又减少了颈部僵硬与不适。

Objective To evaluate the clinic significance of the short-segmental fixation with single posterior route lateral mass fixation systems after posterior unilateral open-door laminoplasty in cervical spondylotic myelopathy. Methods 56 patients with cervical spondylotic myelopathy were reviewed in the past six years. We evaluated the operation means on the JOA score and images which we got preoperation and postoperation. Results 56 patients all suffered from the cervical spondylotic myelopathy which affected more than three cervical spinal segments. All the operations were taken under general anesthesia. The spine canal were decompressed from C3 to C7. The single posterior route lateral mass fixation and the bone grafting were done from C4 to C6. All cases obtained follow-up with average 32 months. The JOA score increased from 9.2 （preoperation）to 14.6 （postoperation）. The rate of excellent and good were 78%. Conclusion Posterior route unilateral open-door laminoplasty is a safe and effective operation means in cervical spondylotic myelopathy. The single posterior route lateral mass fixation system will add its safety and effect. It has some merits as followed： 1. Maintaining the nature arc of cervical spine. 2. Adding the stability after operation and making the union of bone grafting easier. The patients can take off the external fixation earlier. 3. The silk threads through the processus spinosus are fixed on the lateral mass fixation systems. So the phenomena of ＂reclose of the opened laminae＇is avoided. 4. The short-segmental fixation decrease the ankylosis and discomfort of cervical spine.