颈椎后路单开门微型钛板固定治疗多节段脊髓型颈椎病的临床疗效

Clinical effects of cervical posterior single door mini titanium screw-titanium plate fixation for multi-segment cervical spondylotic myelopathy

目的:讨论颈椎后路单开门微型钛板固定术在治疗多节段脊髓型颈椎病的临床应用及其近期随访结果。方法:自2010年3月～2012年3月在我院行颈椎后单开门微型钛板固定术并获得完整随访病例的脊髓型颈椎病患者42例,手术开门减压节段均为C3-C7,术中将预弯成"Z"形的6孔微型钛板两端分别固定于开门后的椎板和门轴侧侧块上,用以取代传统的丝线悬吊固定法。通过影像学及临床表现观察所有病例的治疗效果。结果:所有患者据均未出现术中神经、血管损伤等并发症。患者术后随访6～12个月,平均9个月,影像学检查显示内固定牢固,未见钛板及钛钉脱落、移位、椎板折弯塌陷及再关门现象。术后JOA评分较术前明显提高;术前平均为8.9(7～11)分,术后平均为13.2(8～16)分;患者在接受手术后JOA平均改善率为53.72%(14.9%-81.6%);手术后6个月的JOA平均改善率为54.25%(17.94%～84.75%)。术后颈椎轴性症状(AS)的评价;术后6个月AS平均改善率65.4%(24.8%～86.0%)。结论:颈椎后路单开门微型钛板固定术治疗多节段脊髓型颈椎病疗效确切,操作简便,神经功能及临床症状得到明显恢复及改善,值得临床推广。

Objective： To discuss the clinical effects of cervical posterior single door mini titanium screw-titanium plate fixation for multi-segment cervical spondylotic myelopathy（MCSM）.Methods： From March 2010 to March 2012,a total of 42 cases with multi-segment cervical spondylotic myelopathy（MCSM） underwent cervical posterior single door mini titanium screw-titanium plate fixation.Decompression ranged from C3 to C7.During the operation,＂Z＂ shape miniature titanium plate was fixed in vertebral plate and gate shaft to replace the traditional silk suspension fixation.Observed the therapeutic effect according to imaging and clinical manifestation.Results： No intraoperative complications such as nerve or blood vessel damage was observed.According to a mean follow-up of 9 months（6-12months）,radiographic inspection displayed firm inner fixation,no screw loosening or reclose of the opened laminae.Postoperative JOA score increased from 8.9（7-11） points to 13.2（8-16） points after undergping the operation,52.82%（15.6%-80.5%） of patients showed improved JOA score after the operation,this percentage increased to54.25%（17.94%-84.75%） 6 months after undergoing the operation.65.4%（24.8%-86.0%） patients showed improved postoperative cervical shaft symptoms（AS） 6 months after the operation.Conclusion： Cervical posterior single door mini titanium screw-titanium plate fixation can improve the nerve function and clinical symptoms for patients with multi-segment cervical spondylotic myelopathy.