颈椎单开门椎管成形术结合微型钛板内固定治疗多节段脊髓型颈椎病

Treatment of unilateral open-door cervical expansive laminoplasty fixed by titanium miniplate for multilevel cervical spondylotic myelopathy

目的：探讨颈椎后路微型钛板内固定结合单开门椎管成形术治疗多节段脊髓型颈椎病的临床效果。方法2008年3月至2011年10月山东大学齐鲁医院沂南分院采用单开门椎管成形术结合微型钛板内固定治疗34例多节段脊髓型颈椎病患者，对患者术前及术后3周、15个月日本骨科学会（JOA）评分、椎管矢状径、轴性症状严重程度、颈椎活动度（ROM）进行评估。结果所有患者获随访10～18个月，平均随访时间13个月。术后3周、15个月JOA评分及椎管矢状径较术前均明显提高（P＜0.05）；术后3周及15个月的JOA评分、椎管矢状径比较，差异无统计学意义（P＞0.05）。颈部轴性疼痛发生率12%。术后ROM较术前有所降低，但差异无统计学意义（P＞0.05）。结论颈椎后路微型钛板内固定结合单开门椎管成形术是治疗多节段脊髓型颈椎病安全有效的方法。

Objective To analyze the clinical effect of posterior unilateral open-door expansive laminoplasty with the use of titanium miniplate for patients with multilevel cervical spondylotic myelopathy （MCSM）. Methods From March 2008 to October 2011, cervical posterior unilateral open-door expansive laminoplasty fixed by titanium miniplate were performed in 34 MCSM patients in Yinan Subhospital of Qilu Hospital of Shandong University. Japanese Orthopaedic Association （JOA） scores, sagittal diameter of spinal canal, degree of axial symptom （AS） and range of motion （ROM） of neck were evaluated at preoperation, 3 weeks and 15 months after the surgery. Results All patients were followed up from 10 to 18 months （average, 13 months）. JOA scores and sagittal diameter of spinal canal showed significant differences after surgery （P 〈0.05）, but there were no statistical differences in the above parameters between 3 weeks＇ and 15 months＇ follow up （P 〉0.05）. Incidence of AS was 12%. ROM of neck decreased after the operation, but the difference between preoperation and postoperation had no statistical significance （P 〉0.05）. Conclusion Cervical posterior unilateral open-door expansive laminoplasty with the use of titanium miniplate is an effective and safe approach for MCSM.