改良单开门微型钛钉-钛板内固定在颈椎管扩大成形术中的应用

Modified unilateral open-door cervical laminoplasty using miniscrew-plates fixation

目的探讨改良单开门微型钛钉-钛板内固定在颈椎管扩大成形术中临床应用的初步效果。方法利用微型钛钉-钛板固定方法行颈椎后路单开门手术治疗颈椎管狭窄症18例,手术减压节段包括C3～C75个节段,手术方式均采用单开门,椎板抬起(开门)后,剪取合适大小及形状的钛板,利用微型钛钉将其分别固定在抬起的椎板及侧块上。结果术中及术后均未见因钛板及钛钉置入引起的脊髓、神经根及血管损伤。随访3～18个月,术后JOA评分均有明显改善,术后行CT检查未见钛板及钛钉脱落移位、椎板塌陷或再关门现象,门轴侧骨折处骨质再生融合。结论改良单开门微型钛钉-钛板内固定行颈椎管扩大成形术是一种简单、可靠、安全、有效的方法。

[Objective] To explore the preliminary results of clinical application of cervical laminoplasty using miniscrew-plates fixation.[Method] Posterior unilateral open-door laminoplasty using miniscrew-plates fixation was performed on 18 patients of cervical spinal stenosis.Operative decompression included 5 levels from C3 to C7. Uni- lateral open-door technique was used in all the patients, after the laminae were elevated （opened）, a titanium mini- plate was cut and modified into a suitable size and shape, and was fixed to the elevated laminae and lateral masses using miniscrews. [Result] There was no injury of spinal cord, nerve roots or vertebral artery due to the miniscrew- plates insertion during and after the operation.Follow-up ranged 3-18 months, JOA score increased obviously after the operation. In the period of follow-up, there was no screw loosening or displacement. Postoperative CT was per- formed on all cases, in which, there was no laminae subsidence or reclose of the opened laminae. Bone regrowth and fusion in the gutter of hinged side was shown in all cases. [Conclusion] Using miniscrew-paltes fixation for cervical laminoplasty is a simple, durable, safe and effective method.