颈椎“双开门”椎管扩大成形人工骨植骨治疗颈椎疾患的疗效分析

The clinical outcome of posterior cervical double-door expansive laminoplasty with hydroxyapatite artificial bone

目的:总结分析颈椎后路双开门椎管扩大成形羟基磷灰石人工骨(hydroxyapatite artificial bone,HAB)植骨治疗颈椎疾患的临床效果。方法:对130例行颈椎后路"双开门"椎管扩大成形HAB植骨治疗的患者进行回顾性分析,采用JOA评分法、颈椎管平均矢状径、颈椎屈伸活动度、颈椎弯曲类型中前弯型比率、相邻椎间的稳定性评价临床疗效,X线、CT判定植骨融合状况。结果:术后所有患者症状体征得到改善,JOA评分由术前平均10.8分增加至出院时平均14.0分,改善率为51.6%;最狭窄部颈椎管平均矢状径由术前8.8mm增加至15.4mm,扩大率为75.0%;颈椎屈伸活动度由术前41.6°±10.2°下降为25.2°±11.2°;前弯型比率由术前79.2%下降为73.9%。4例出现相邻椎间失稳。平均随访5年7个月,术后5年时人工骨骨性融合率为56%。结论:应用HAB的颈椎后路双开门椎管扩大成形术是一种安全、有效、有应用价值的手术方法。

Objective：To study the result of posterior cervical double-door expansive laminoplasty with hydroxyapatite artificial bone （HAB）.Method：Retrospeetive reviews were done to 130 patients underwent posterior cervical double-door laminoplasty with HAB.All patients were evaluated by JOA scores,cervical canal sagittal diameter,the range of motion in flexion-extension movement,cervical curvature and stability of adjacent segments.Bone fusion was determined on X-ray and CT at follow-up.Result：All patients were followed up for an average of 5 years and 7 months.Clinical symptoms and physical signs were improved in all the patients after operation.JOA scores increased from 10.8 to 14.0 on an average,the improvement rate of JOA scores was 51.6%.The average cervical canal sagittal diameter in the most narrow position improved from 8.8 to 15.4,the expansion rate was 75.0%.The range of motion in flexion-extension movement reduced from 41.6±10.2°to 25.2±11.2° ,the rate of procurvation reduced from 79.2% to 73.9%.Postoperative instability in adjacent segments happened in 4 cases.The union rate of HBA was 56% in 5 years.Conclusion：Double-door expansive laminoplasty with HAB is safe and effective.HAB is applicable and promising in the cervical posterior double-door expansive laminoplasty.