单侧开门外侧块螺钉固定植骨治疗颈脊髓压迫症

Single open door laminoplasty with lateral mass screw fixation and bone graft in the treatment of the patients with cervical spinal cord compression

目的探讨单侧开门外侧块螺钉固定植骨术治疗颈脊髓压迫症的临床疗效。方法自2004—02-2008—06采用单侧开门外侧块螺钉固定植骨术治疗颈脊髓压迫症26例，男18例，女8例；年龄51～67岁，平均58岁。26例中有22例为多节段脊髓型颈椎病（3个或3个节段以上），其中10例合并发育性椎管狭窄症（6例合并动力性椎管狭窄症，3例合并后纵韧带骨化症，1例为外伤性）；4例为颈椎管内肿瘤。随访9个月-2年2个月，平均1年8个月。结果疗效评定标准参照日本整形外科协会（JOA）评分标准，优8例，良15例，可2例，差1例，优良率为88．5％。无一例出现血管损伤或内固定物断裂并发症，1例脊膜瘤因肿物过大术后出现脊髓再灌注损伤表现，经积极治疗好转，生活可自理。结论该法适用于需要从后方人路进行减压的颈脊髓压迫症，疗效肯定。其优点是手术相对安全，在彻底减压的同时进行坚强的内固定，尤其适用于伴有节段性不稳的脊髓型颈椎病。

Objective To investigate the clinical efficacy of single open door laminoplasty with lateral mass screw fixation and bone graft for the treatment of cervical spinal cord compression. Methods From February 2004 to June 2008, the single open door laminoplasty with unilateral lateral mass screw fixation and bone grafting was used to treat 26 patients with cervical spinal cord compression,including 18 male patients,8 female patients ; aged 51 to 67 years old ; the average age was 58 years old. Among 26 patients, there were 22 patients suffered multi - segmental cervical spondylotic myelopathy（three or more than three segments）. Of them 10 patiens complicated with developmental spinal stenosis ,6 patients with power spinal stenosis ,3 patients with ossification of posterior longitudinal ligament,one case was traumatic. Another 4 patients suffered from the cervical spinal canal tumor. Follow -up time was 9 months to 26 months,with an average of 20 months. Results The efficacy were evaluated by reference to Japan Association of Plastic Surgery （JOA） score standards. There were excellent in 8 patients,good in 15 patients,fair in 2 patients,poor in 1 patient, the excellent and good rate was 88.5%. No patient had vascular injury or internal fixator fracture,one patient with meningioma occurred spinal cord ischemia - reperfusion injury ofter operation due to too large tumor, the disease cordition was improved by active treatment, and had self - care ability. Conclusion The method can be applied to the patients with cervical spinal cord compression required to carry out posterior, and its efficacy is positive. The advantage is the relative safety of surgery, simultaneous performance of a thorough decompression and a strong fixatiom. It is applied particularly to treat the patients with cervical spondylotic myelopathy complicated with segmental instability.