颈椎单开门微型钛板固定与缝线悬吊固定治疗颈椎病

Mini titanium plate fixation versus suture suspension fixation in ELAP for treatment of cervical spondylotic myelopathy

[目的]探讨颈椎单开门椎管扩大成形术(expansive open-door laminoplasty,ELAP)中微型钛板固定技术与传统缝线悬吊固定技术治疗脊髓型颈椎病的临床疗效。[方法]以2008年6月～2010年6月本院微型钛板固定ELAP术治疗的23例脊髓型颈椎病患者为A组,选择同期采用传统缝线悬吊"门轴"ELAP术治疗的23例患者为B组。比较两组间的手术时间、术中出血量,随访时JOA评分改善率、颈椎曲度变化值、轴性症状及椎板掀开角度。[结果]两组随访时间[A组为(13.5±3.5)个月、B组为(14.1±3.2)个月]、手术时间[A组(121±35)min、B组(112±30)min]、术中出血量[A组(330±115)ml、B组(328±123)ml]和JOA评分改善率[A组(58.3±9.7)、B组(56.7±8.9)]差异无统计学意义(P>0.05);A组颈椎曲度术前(17.2°±4.2°)与术后(17.9°±5.2°)差异无统计学意义(P>0.05),B组颈椎曲度术前(18.2°±4.7°)与术后(16.3°±4.5°)差异有统计学意义(P<0.05),颈椎曲度变化率两组差别有统计学意义(A组0.7°±4.9°,B组-1.9°±3.7°,P<0.05)。A组术后轴性症状(10.1±1.8)与B组(9.2±2.1)比较差异有统计学意义(P<0.05);椎板开门角度A组(37.3°±5.4°)与B组(35.7°±6.1°)差异无统计学意义(P>0.05)。[结论]颈椎单开门椎管扩大成形术中微型钛板固定技术与传统缝线悬吊固定技术治疗脊髓型颈椎病均能获得较好的临床疗效,但微型钛板固定颈椎单开门椎管扩大成形术可减轻术后轴性症状和防止颈椎曲度的丢失。

[Objective]To evaluate the clinical efficacy of the mini titanium plate fixation versus the traditional suture suspension fixation in the expansive open-door laminoplasty（ELAP） in the treatment of cervical spondylotic myelopathy（CSM）. [Methods]Twenty three patients with CSM were treated with ELAP by mini titanium plate fixation from June 2008 to June 2010（group A）.At the same time,23 patients with CSM were selected to receive ELAP by traditional suture suspension（group B）.The efficacy of Group A and Group B was assessed by comparing operation time,blood loss,JOA score improvement rate,value of cervical curvature,axial symptoms,and lamina opened angle. [Results]There were no significant statistical difference between Group A and Group B in follow-up time（13.5±3.5 months vs 14.1±3.2 months）,operation time（121 ± 35min vs 112 ± 30min）,blood loss（330±115 ml vs 328±123 ml） and the JOA score improvement rate（58.3±9.7 vs 56.7±8.9）（P0.05）.There was no significant statistical difference between the preoperative cervical curvature and the postoperative cervical curvature（17.2°±4.2° vs 17.9°±5.2°） in Group A（P 0.05）,and there was significantly statistical difference between the preoperative cervical curvature and the postoperative cervical curvature（18.2°±4.7° vs 16.3°±4.5°） in Group B（P 0.05）.The rate of cervical curvature was significantly different between groups（0.7°±4.9° vs-1.9°±3.7°,P0.05）.There was significantly statistical difference in the postoperative axial symptoms between Group A（10.1±1.8） and B（9.2±2.1）（P0.05）.There was no significantly statistical difference in the lamina open-angle between Group A（37.3°±5.4°） and B（35.7°±6.1°）（P0.05）. [Conclusion]ELAP with mini titanium plate fixation or with suture suspension technique can obtain good clinical efficacy in the treatment of CSM.The mini titanium plate fixation,however,can reduce postoperative axial symptoms and prevent the loss of cervical curvature.