后路单开门Centerpiece内固定治疗多节段脊髓型颈椎病

Treatment of Multi- segmental Cervical Spondylotic Myelopathy Treated Posterior Unilateral Opendoor Laminoplasty Combined with Centerpiece Ttitanium Plate Internal Fixation

目的探讨颈后路单开门结合Centerpiece钛板内固定术治疗多节段脊髓型颈椎病的临床疗效和安全性。方法自2010年5月至2012年5月,采用颈后路单开门结合Centerpiece钛板内固定术治疗多节段脊髓型颈椎病患者32例,男20例,女12例;年龄49～77岁,平均（60.4±7.6）岁。以日本骨科协会（Japanese orthopaedic association,JOA）17分法评定神经功能,在侧位X线片上测量C2与C7椎体后壁切线夹角α确定颈椎曲度,以过伸过屈位α的差异来计算颈椎活动度,以颈肩疼痛视觉模拟评分（visual analogue scale,VAS）评估。结果手术均顺利完成,手术时间100～160 min,平均140 min;手术失血量250～800 mL,平均460 mL。所有患者均获得随访,随访时间12～38个月,平均22个月。术前和术后1周JOA分别为（9.26±3.16）分、（12.95±2.35）分（P〈0.05）,JOA改善率为（56.4±9.3）%;术后3个月和术后1年JOA分值分别为（13.30±2.46）分、（13.16±1.39）分,与术后1周（12.95±2.56）分相比,差异均无统计学意义（P〉0.05）;患者术前、术后3个月颈椎曲度分别为（18.1±3.8）°和（16.7±5.4）°,两者差异无统计学意义（P〉0.05）;患者术前、术后3个月颈椎活动度分别为（35.46±11.54）°和（30.65±8.95）°,两者差异无统计学意义（P〉0.05）;术前、术后3个月平均颈肩部VAS评分分别为（3.8±1.8）分和（1.6±1.5）分,两者差异有统计学意义（P〈0.05）。结论颈后路单开门结合Centerpiece钛板内固定术治疗多节段脊髓型颈椎病能够有效改善多节段脊髓型颈椎病患者神经功能,保存颈椎曲度及活动度,是治疗多节段脊髓型颈椎病的有效方法。

Objective To explore the clinical effect and safty of posterior unilateral open-door laminoplasty combined with Centerpiece titanium plate internal fixation for multi-segmental cervical spondylotic myelopathy. Methods From May 2010 to May 2012,32 patients with multi-segmental cervical spondylotic myelopathy were treated by posterior unilateral open door laminoplasty combined with Centerpiece titanium plate internal fixation. There were 20 males and 12 females,with a mean age of（ 60. 4 ± 7. 6） years（ ranged 49 to 77 years）. The neurofunction was evaluated by Japan Orthopaedic Association（ JOA） score. The cervical curvature angle（ α） was demonstrated by the cross angle between posterior vertebral body margins of C2and C7on cervical radiographs. Calculated cervical range of motion according to the difference of the angle of α between hyperextension and hyperflexion cervical radiographs. Calculated shoulder and pain VAS scores assess the range of axial symptoms. Results The operative time and intraoperative blood loss were respectively 140 min（ 100 ～ 160 min） and 460 mL（ 250 ～ 800） mL. All patients were followed up from 12 to 38 months with an median of 22 months. The JOA scores was（ 9. 26 ± 3. 16） before surgery and（ 12. 95 ± 2. 35） at 1 week after surgery,which showed significant differences（ P〉0. 05）. The improve rate of Japanese Orthopaedic Association（ JOA） scores was（ 56. 4 ± 9. 3） %. The JOA scores was（ 13. 30 ± 2. 46） 3 months after surgery and（ 13. 16 ± 1. 39） 1 year after surgery,there were no significant differences when compared with the JOA scores at 1 week after surgery（ P〈0. 05）. The cervical curvature angle were（ 18. 1 ± 3. 8） ° before surgery an（ 16. 7 ± 5. 4） ° 3 months after surgery. There were no significient differences（ P〉0. 05）. The cervical range of motion was（ 35. 46 ± 11. 54） ° before surgery and（ 30. 65 ± 8. 95） ° 3 months after surgery. There were no significient differences（ P〈0. 05）. The VAS scores were（（ 3. 8 ±1. 8） before surgery and（ 1. 6 ±1. 5） 3 months after surgery,which had significient differences（ P〈0. 05）. Conclusion Posterior unilateral open-door laminoplasty combined with Centerpiece titanium plate internal fixation can effectively improve neurofunction of patients with multi-segmental cervical spondylotic myelopathy and conserve cervical curvature and activity. It is an effective and safe method for multi-segmental cervical spondylotic myelopathy.