颈后路单开门单侧短节段侧块内固定治疗脊髓型颈椎病并颈椎失稳症

The Clinic Significance of the Short-Segmental Lateral Mass Plate Fixation after Posterior Route Unilateral Open-Door Laminoplasty in the Treatment of Cervical Spondylotic Myelopathy and Instability of Cervical Vertebrae

目的：探讨一次完成颈后路单开门并单侧短节段侧块内固定治脊髓型颈椎病并颈椎失稳的可行性及治疗效果.方法：本组选取脊髓型颈椎病并颈椎失稳患者25例,术前X线片测量均有椎体间不稳,磁共振显示脊髓受压明显;手术采用颈后路单开门减压椎管成形术,不稳节段单侧短节段侧块内固定并关节突间植骨融合术.结果：术中未出现并发症,术后神经症状明显改善,拍片检查提示置钉位置正确,随诊11～18个月,平均13个月,术后3～6个月X线显示25例患者固定节段关节突有骨小梁生成,融合率达100%.25例术前JOA评分为10.39±2.40,术后随访时达到14.36±1.64;3例患者（4枚螺钉）出现螺钉松动,发生在钢板头侧.结论：一次完成颈后路单开门并单侧短节段侧块内固定治疗脊髓型颈椎病并颈椎失稳是一种简捷、可靠的治疗方法,避免了前后路联合手术,近期内疗效满意.

Objective： To explore the feasibility and outcome of he short--segmental lateral mass plate fixation after posterior route unilateral open--door laminoplasty in treating cervical spondylotic myelopathy and instability of cervical vertebrae at one time. Methods： The preoperative radiographs of 25 patients were measured and were diagnosed to be spondylotic myelopathy and instability of cervical vertebrae. MRI showed the spinalcords were compressed obviously. The spine canal were decompressed from C3 to C7. The lateral mass plate were used in the unstable segments. Results： Complications were not found after the operation. The postoperative radiographs showed that the screws were in the right places. The average follow-up time was 13 months,ranging from 11 to 1 8 months. The short--term radiographs showed firmly fixed screws, and no breakage of plates and screws were found. There were four screws loosen on the up top of the plate in 3 case. Solid arthrodesis was achieved in 25 patients（100%）, the JOA scores were （ 10.39 ± 2.40） preoperatively and improved to （ 14.36 ± 1.64） at final follow-up. Conclusion： It is a simple and reliable method to treat cervical spondylotic myelopathy and instability of cervical vertebrae at one time with the short-segmental lateral mass plate fixation after posterior route unilateral open-door laminoplasty. Anterior short-term outcome is satisfied.