“锚定法”改良单开门椎板成形术治疗多节段脊髓型颈椎病

Modified open door laminoplasty by using anchor method for treating multi-segmental cervical spondylotic myelopathy

目的评价"锚定法"改良单开门椎板成形术治疗多节段脊髓型脊椎病的疗效。方法我科在2003年1月～2007年2月收治78例多节段脊髓型颈椎病,采用后正中入路单开门椎板成形术进行回顾性分析。结果 78例患者获得随访1～5年,平均2.6年。术前平均JOA评分8.9分,随访时JOA平均评分15.8,平均改善率为69%。术后侧位X线片示椎管直径扩大1.8～7.6 mm,平均4.7 mm,椎管扩大率为16%～100%,平均45%;MR示脊髓解除压迫。术后末次随访时35例仍然有颈部疼痛、僵硬感和活动受限。未见螺钉松动和再"关门"现象。结论 "锚定法"改良单开门椎板成形术是治疗多节段脊髓型脊椎病安全有效的手术方法,并使椎管扩大保持稳定持久。

Objective To investigate the clinical efficacy of modified open door laminoplasty using anchor method treating multi-segmental cervical spondylotic myelopathy. Methods From January 2003 to February 2007,78 cases with multi-segmental cervical spondylotic myelopathy used modified open door laminoplasty were analyzed retrospectively. Results 78 cases were followed-up 1 to 5 years （average 2.6 years）. The average preoperative JOA score was 8.9 and postoperative JOA score was 15.8 ,the average improvement rate was 69%. Postoperative lateral radiograph showed that spinal canal was enlarged from 1.8 to 7.6 mm （average 4.7 mm） in diameter. Spinal canal expansion rate was 16%-100% （average 45%）. MRI film showed that the compression of spinal cord was relieved. Fifty- five cases still had pain, stiffness and limitation activity in neck postoperative terminal follow-up period. There was no case of screw loosening and door re-closure phenomenon. Conclusion Modified open door laminoplasty with anchor method is a safe and effective surgical technique. It is would keep spinal canal. Enlargement in the stable and persistent status.