重建钢板内固定在颈椎管扩大成形中的应用

Application of the reconstrction internal fixation with steel plate on cervical laminoplasty

目的探讨重建钢板内固定在后路单开门椎管扩大成形术的可行性，并报告初步临床效果。方法选择27倒脊髓型颈椎病患者实施后路单开门椎管扩大成形术，手术减压范围：C3-C7者24例，C3～C6者3例。椎板抬起后，用塑性好、长度合适的重建钢板固定于棘突根部和同位椎侧块，术中不咬除棘突和棘上韧带。结果术中无因为植入钢板而引起神经血管损伤，手术时间延长15—30min，随访6～32个月，术后3个月JOA评分由术前8．7分提高到12．7分，6个月提高到13．6分，6个月以后改善不明显。手术后CT显示椎管扩大满意，门轴骨愈合率96．7％，随访期间2例发生鹅颈畸形，5例出现轴性症状。结论重建钢板开门侧固定有利于门轴侧骨性融合，由于保留了后方的棘突和韧带，术后颈椎的生理弧度和稳定性良好，鹅颈畸形及轴性症状发生率低。

Objective To analyse the feasibility of formation operation of expanded vertebral canal with internal fixation of reconstruction steel board through posterior but open approach, and report the initial clinical effect. Methods Twenty - seven patients with spinal cord type of cervical spondylosis were choosed to perform the formation operation of expanded vertebral canal with internal fixation of reconstruction steel board through posterior but open approach. The scope of operation decompression： C3 - C7 24 cases, Ca - C6 3 cases. After the vertebral lamina was lift up, a flexible and appropriate reconstruction steel board was fixed on the root of spinous process and the same - position vertebral laretal mass. there was no need to bite off the spinous process and the supraspinallig. Results The implant steel board doesn＇t lead to nerve and blood vessel injury during the operation. The operation time prolonged 15 -30 minutes. All patients were followed up for 6 to 32 months. After 3 mouths＇ postoperation healing,the JOA scores were enhanced from 8.7 in preoperation to 12.7 in postoperation, the scores enhanced 13.6 in 6 mouths. It improve little after 6 mouths. The CT shows the vertebral canal was enlarged appropriately. The healing rate was 96.7%. During the follow - up period, we found that 2 cases have the deformity of goose neck and 5 cases have the pivotal symptom. Conclusions The open lateral fixation of reconstruction steel board can promote the door - oriented bone combination. On account of keeping the back spinous process and ligament, the postopetative physiological radian and stability proves good. As a result, the deformity of goose neck and the pivotal symptom appears quite low.