微型钛板改良单开门颈椎管扩大成形术治疗脊髓型颈椎病的临床效果

Clinical effect of modified single open-door laminoplasty using titanium miniplate fixation in treatment of cervical myelopathy

目的评价微型钛板改良单开门颈椎管扩大椎板成形术治疗脊髓型颈椎病的临床效果。方法2008年1月-2012年2月，观察46例多节段脊髓型颈椎病（MCSM）行微型钛板改良单开门颈椎管扩大椎板成形术的脊髓型颈椎病患者，对比术前及术后JOA评分，在cT上测量c5，节段椎管术前、术后6个月的矢状径，计算椎管扩大率[（术后椎管矢状径-术前椎管矢状径）／（术前椎管矢状径）×100％]，观察单开门门轴侧骨融合情况。结果平均随访18个月（6-24个月）。术前平均JOA评分8．2分，术后平均JOA评分14．8分。节段椎管矢状径术前为8．6±1．1mm，术后6个月为16．1±0．9mm，椎管扩大率为（74．3±14．4）％。术后6个月，可以观察到单开门门轴侧骨融合，无螺钉松动及再“关门”现象。结论微型钛板改良单开门椎管成形术治疗脊髓型颈椎病临床效果满意，防止再关门。

Objective To evaluate the clinical effect of single open-door cervical expansive laminoplasty （ELP） in treatment of cervical spondylosis. Methods From January 2008 to February 2012, a total of 46 patients with multi-segment cervical spondylotie myelopathy （MCSM） were implemented open-door cervical expansive laminoplasty with titanium miniplate fixation. The preoperative and postoperative JOA scores, cervical C5 segmental sagittal diameter in preoperation and 6 months after operation were evaluated, and the expansion rate of spinal canal was measured [ （postoperative sagittal diameter-preoperative sagittal diameter）/（preoperative sagittal diameter）x100%]. Results The mean follow-up was 18 months （6 to 24 months）. The average pre-OP JOA score was 8.2 and post- OP JOA score was 14.8. The mean sagittal diameter of Cs spinal canal was 8.6±l.lmm before operation and 16.1±0.9mm at 6 months after operation,with the expansion rate of 74.3±14.4%. CT scan showed bony fusion at hinge side at 6 months after operation. There was no case of screw loosening and reclosed door. Conclusion Modified single open-door cervical expansive laminoplasty with titanium miniplate fixation would obtain satisfactory clinical effect, it is able to reduce the probability of reclosed door.