颈椎侧块钢板在颈椎病合并颈椎不稳手术治疗中的应用

The application of cervical lateral mass plate fixation in treatment of cervical spondylotic myelopathy combined with cervical spine instability

目的探讨颈椎侧块钢板螺钉内固定在脊髓型颈椎病合并颈椎不稳手术治疗中的应用。方法2002年1月至2006年6月，127例脊髓型颈椎病患者行颈椎后路单开门椎管扩大成形术，其中52例为存在节段性下颈椎不稳定患者，在单开门椎管扩大成形术同时行不稳定节段侧块钢板螺钉内固定治疗（侧块钢板内固定组）;同期75例无节段性下颈椎不稳定患者，行单纯单开门椎管扩大成形术（单开门组）作为对照。对两组患者的综合情况及脊髓功能改善率进行比较。结果随诊4～57个月，平均（20．46±13．21）个月，两组患者在年龄分布、住院时间、手术时间、术中出血量和输血量等方面比较差异无统计学意义（P〉0．05）。手术前脊髓功能评分两组相近，手术后近期脊髓功能改善，侧块钢板内固定组优良率为86．54％（45／52），单开门组优良率为88．00％（66／75），两组比较差异无统计学意义（P〉0．05）。随诊时远期脊髓功能改善，侧块钢板内固定组优良率为100．00％（52／52），单开门组优良率为88．00％（66／75），两组比较差异有统计学意义（P〈0．05）。结论应用颈椎侧块钢板螺钉内固定结合颈椎后路单开门椎管扩大成形术治疗合并颈椎不稳的脊髓型颈椎病，能够保证植骨融合，维持颈椎稳定，防止术后畸形发生，有利于远期脊髓功能恢复，是一种安全、可靠、有效的治疗方法。

Objective To discuss the apphcation of cervical lateral mass plating for the operative treatment of cervical spondylotic myelopathy combined with cervical spine instability. Methods The single open-door laminoplasty was performed for the treatment of 127 patients with cervical spondylotic myelopathy from January 2002 to June 2006. Fifty-two of 127 patients were combined with cervical spine instability and treated using lateral mass plating spontaneously （Group of lateral mass plating）. Seventy-five of 127 patients without cervical spine instability were treated using single open-door laminoplasty only, as control （Group of only single open-door）. The comparison of age groups,hospital stay,time of operation,bleod loss,bleod transfusion, and the spinal function recovery rates were observed. Results All patients were followed up 4 to 57 months,average of （20.46± 13.21 ） months. There was no significant difference between two groups for age groups, hospital stay, time of operation, blood loss, and blood transfusion （P 〉 0.05）. The preoperative scores of spinal function were similar in two groups. The excellent and good immediately postoperative spinal function recovery rates were 86.54%（45/52）in Group of lateral mass plating and 88.00%（66/75 ）in Group of only single open-door. There was no significant difference between two groups （P 〉 0.05）. The excellent and good late postoperative spinal function recovery rates were 100.00% （52/52） in Group of lateral mass plating and 88.00% （66/75） in Group of only single open-door. The spinal function recovery rate was superior in Group of lateral mass plating to that in Group of only single open-door in the long-term follow-up. There was significant difference between two groups （P〈 0.05）. Conclusions The lateral mass plating is a safe,reli-able, effective method for the treatment of cervical spondylotic myelopathy in combination with cervical spine instability. It can improve the long-term spinal function recovery rates by bone graft fusion, cervical spine stability and preventing deformity.