颈椎单开门椎管扩大术缝线悬吊与钛板固定疗效比较

Comparison of clinical efficacy between titanium plate fixation and suture suspension fixation in the expansive open-door laminoplasty

目的对比分析缝线悬吊固定与微型钛板固定两种技术应用于颈椎单开门椎管扩大术中治疗颈椎管狭窄的临床疗效。方法 2008-11～2011-11我院收治颈椎管狭窄患者中符合颈椎单开门椎管扩大术适应证并接受此手术治疗的患者37例。其中16例患者术中行缝线悬吊固定,为A组;21例患者术中行微型钛板固定,为B组。随访过程中分别记录并对比两组患者手术时间、术中出血量、JOA评分及轴性症状发生情况。根据患者X线、CT等影像学资料测量颈椎曲度和C5节段椎管矢状径,并观察门轴侧骨融合情况。通过上述数据评价术后神经功能及椎管扩大和维持情况。结果两组手术时间、术中出血量无明显统计学差异。根据术后12个月JOA评分,两组间神经功能改善率比较无统计学差异(P>0.05)。术后12个月轴性症状发生率A组62.5%,B组19.0%,两组比较具有统计学差异(P<0.05)。A组颈椎曲度术前为20.5°±1.8°,术后12个月为18.8°±1.3°,有统计学差异(P<0.05);B组颈椎曲度术前20.3°±1.6°,术后12个月19.9°±1.5°,无统计学差异(P>0.05)。C5节段椎管矢状径术前及术后12个月两组比较均无明显统计学差异(P>0.05)。门轴侧骨融合率A组93.8%,B组100%,两组经卡方检验具有统计学差异(P<0.05)。结论颈椎单开门椎管扩大术中应用微型钛板固定比缝线悬吊固定能够更坚强地固定掀开的椎板,进而有利于门轴侧骨折处骨融合,同时能在一定程度上避免发生术后轴性症状和颈椎曲度丢失。

Abstract： Objective To compare the clinical efficacy of the suture suspension fixation versus the titanium plate fixation in the expan- sive open-door laminoplasty for cervical spinal stenosis. Methods A total of 37 patients with cervical spinal stenosis undergoing ex- pansive open-door laminoplasty from November 2008 to November 2011 were enrolled in this study. Sixteen patients were treated with expansive open-door laminoplasty by suture suspension as group A,and the other 21 patients were selected to receive expansive open- door laminoplasty by titanium plate as group B. The operation time, the blood loss during operation, Japanese orthopaedic association scores for assessment of cervical myelopathy and the incidences of axial symptoms were compared between two groups. According to the imaging examination data including X-rays and CT, the cervical curvature angle, spinal canal diameter of C5 and bone fusion on the hinge side were analyzed to evaluate the postoperative neurofunction and spinal canal enlargement. Results There was no significant difference with regard to the operation time,the blood loss and the improvement rate of neurofunction between two groups（P 〉 0.05 ）. The rate of axial symptoms at 12 months after operation in group A was significantly higher than that in group B（62.5% vs 19.0% , P 〈 0.05 ）. The curvature angle of cervical vertebrae in group A was significantly statistical different before and after operation（20.5° ± 1.8° vs 18.8° ± 1.3° ,P 〈 0.05 ）, while no significant difference was found in group B （ P 〉 0.05 ）. The spinal canal diameter of C5 showed no significantly statistical difference between two groups before operation and at month 12 after operation（P 〉 0.05 ）. Bone fu- sion on the hinge side was higher in group B than that in group A（ 100% vs 93.8% ,P 〈0.05）. Conclusion Compared with the su- ture suspension fixation,the titanium plate fixation in the expansive open-door laminoplasty is more stable for the elevated laminae to improve bone fusion on the hinge side. At the same time ,the titanium plate fixation could reduce the postoperative axial symptoms and the loss of cervical curvature.