双侧开门外侧块螺钉固定植骨治疗脊髓型颈椎病

Treatment for Cervical Myelopathy by Combination of Expansive Open door Laminoplasty with Lateral Mass Screw Fixation and Bone Graft

目的:对双侧开门外侧块螺钉固定植骨术治疗脊髓型颈椎病进行初步报告,探讨此项技术的手术要点和早期临床效果。方法:自1994年至今,采用双侧开门外侧块螺钉固定植骨术治疗脊髓型颈椎病。41例患者中,男30例,女11例,年龄58～81岁,平均65岁。27例合并发育性椎管狭窄症,17例合并动力性椎管狭窄症,12例合并颈椎间盘突出症,14例合并后纵韧带骨化症,1例合并黄韧带骨化症。随访10个月～4年1个月,平均2年5个月。结果:疗效评定标准参照日本整形外科学会(JOA)评分标准。疗效:优13例,良22例,可3例,差3例,优良率为854%。无1例出现神经或血管损伤或内固定物断裂的并发症,1例术后并发感染,经清创、摘除内固定物和抗生素治疗后治愈。结论:本方法的优点是,在进行后方减压的同时,进行坚强的内固定。本方法适用于需要从后方入路进行减压的颈椎病,尤其适用于伴有节段性不稳的脊髓型颈椎病的治疗。

Objective:To review the preliminary experience on patients with cervical myolopathy treated by combination of expansive open door laminoplasty with lateral mass screw fixation and bone graft.The main point for procedure,surgical technique and clinical effacicy was discussed.Method:From 1994 to present,41 patients with cervical myelopathy were operated by combination of expansive open door laminoplasty with lateral mass screw fixation and bone graft.Among them,30 were male,11 were female.They averaged 65 years of age(58～81 years old).27 cases had cervical developmental stenosis,17 cases dynamic stenosis,12 cases cervical herniation,14 cases ossification of posterior longitudinal ligmentum (OPLL),and one case calcification of ligmentum flavum.Followup period was from 10 months to 4 years and 1 month with an average of 2 year and 5 months.Results:According to Japanese Orthopaedic Association Score,13 cases had obtained excellent results,22 cases good results,3 cases fair results,and 3 cases poor results.85 4% of the patients had obtained excellent or good results.There were no major complications such as neural or vascular injuries or breakage of implants.One patient had complication of late infection and was cured by debridment,removal of the implants,and antibiotics therapy.Condusion:This method has the advantage of both decompression of spinal cord by expansive open door laminoplasty and rigid internal fixation.Its indication for this method is cervical spondylosis which needs posterior decompression via posterior approach,especially for cervical myeolopathy with unstable segments.