微型钛板置入颈椎管成形与单开门椎管扩大治疗脊髓型颈椎病的对比

Minimally invasive cervical laminoplasty versus single-door laminoplasty for treatment of cervical spondylotic myelopathy

背景:郑州大学第一附属医院骨科近年开展一项微创微型钛板置入颈椎管成形治疗脊髓型颈椎病,在保留颈椎重要结构的基础上对颈椎病实现脊髓减压。目的:对比分析微创微型钛板置入颈椎管成形与颈后路单开门椎管扩大成形对脊髓型颈椎病的治疗效果。方法:将78例脊髓型颈椎病患者随机分成2组,分别采用微创微型钛板置入颈椎管成形与颈后路单开门椎管扩大成形治疗。结果与结论:治疗后随访3-36个月。末次随访患者日本骨科学会(JOA)评分优良率两组差异无显著性意义(P>0.05)。治疗后轴性症状明显率微创颈椎管成形组明显低于单开门组(P<0.05),颈曲指数丢失值微创颈椎管成形组显著低于单开门组(P<0.05)。微创颈椎管成形组末次随访1例患者2枚钛钉轻微松动,患者无异常症状。单开门组治疗中6例开门时出现铰链侧断裂,将断裂椎板切除,脊髓表面覆盖人工硬脊膜加以保护。结果表明,微创颈椎管成形组与单开门组相比在脊髓功能恢复方面疗效无差别,但治疗后并发症远低于单开门组。

BACKGROUND： In recent years, a single-door laminoplasty for cervical spondylotic myelopathy was performed in the Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University. This surgery achieved spinal decompression while remaining the important structure of cervical vertebra. OBJECTIVE： To comparatively analyze the therapeutic effects of minimally invasive cervical laminoplasty and single-door laminoplasty on cervical spondylotic myelopathy. METHODS： A total of 78 cases of cervical spondylotic myelopathy were randomly divided into two groups, which respectively received minimally invasive cervical laminoplasty and single-door laminoplasty. RESULTS AND CONCLUSION： All cases were followed-up for 3-36 months. No significant difference in excellent and good rate of Japanese Orthopaedic Association score was detected between the two groups in final follow-up （P 〉 0.05）. The apparent rate of axial symptoms was significantly lower in the minimally invasive cervical laminoplasty group than that in the single-door laminoplasty group after treatment （P 〈 0.05）. Cervical curvature loss was significantly lower in the minimally invasive cervical laminoplasty group than that in the single-door laminoplasty group （P 〈 0.05）. In final follow-up, in the minimally invasive cervical laminoplasty group, two titanium screws of one patient were slightly loose, and no abnormal symptom was observed. In the single-door laminoplasty group, hinge breakage was visible in six patients. The broken vertebral plate was excised. Artificial spinal dura mater was coated on the surface of spinal cord for protection. Results suggested that the effect of two surgical methods in promoting functional recovery of spinal cord is identical. However, complications in the minimally invasive cervical laminoplasty group are further fewer than those in the single-door laminoplasty group.