单开门椎管扩大成形Centerpiece钛板固定术治疗多节段脊髓型颈椎病的临床应用

The clinical application of unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation for multilevel cervical spondylotic myelopathy

目的评价单开门颈椎管扩大成形Centerpiece钛板固定术治疗多节段脊髓型颈椎病的临床应用价值。方法 39例多节段脊髓型颈椎病患者随机分为Centerpiece钛板组(18例)及传统组(21例),治疗前后行JOA评分,比较治疗后神经功能改善率、椎管扩大率、并发症发生率。结果前两组年龄、JOA评分均无显著性差异;两组手术时间分别为(109±25)min和(111±23)min,无显著性差异(P>0.05);Centerpiece钛板组椎管扩大率(61%±21%)明显高于传统组(40%±17%)(P<0.05)。术后3个月、12个月两组JOA评分均显著高于术前,但术后3个月两组间JOA评分无显著性差异(P>0.05),术后12个月Centerpiece钛板组JOA评分明显高于传统组(P<0.05)。术后3～6个月进行CT示门轴侧沟槽达到骨性融合。两组均未发生再关门现象;Centerpiece钛板组并发症发生率显著低于传统组(P<0.05)。结论单开门椎管扩大成形Centerpiece钛板固定术是一种安全有效、操作简单、疗效显著、并发症少的新术式。

Objective To evaluate the efficacy of unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation for multilevel cervical spondylotic myelopathy. Methods 39 patients with multilevel cervical spondylotic myelopathy were randomly divided into ＂centerpiece titanium plate＂ group and ＂tradition＂ group. Befbre and after operation,the JOA score were performed. The improving rate of nerve function,the rate of spinal canal expansion and the rates of complication were compared after operation. Results Before operation,both of the two groups were the same in age and JOA score （P〉0.05）. Two groups of operative time were respec- tively（109~25） rain and （111~23） rain,there were no significant differences between them（PM）.05）. The rate of spinal canal expansion of ＂centerpiece titanium plate＂ group（61%~21%）was obviously higher than＂tradition＂group（40%~17%）（P〈0.05）. The JOA score of two groups at 3 months and 12 months after operation were higher than preoperation. The JOA score of two groups were compared respectively,there were no significant differences at 3 months after operation（P〉0.05）,but＂centerpiece titanium plate＂ group had a significant increase at 12 months after operation （P〈0.05）. CT scan at 3-6 months ＂after operation displayed that door spindle already reach osseous fusion. There were no occurrence of ＂re-close of door＂ in two groups. Conelusion The rates of complication of ＂center- piece titanium plate＂ group were lower than ＂tradition＂ group （P〈O.05）. Conclusion Unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation is a new opera- tion which is safe,simple,effective with few complication.