颈椎后路单开门微型钛板固定成形术治疗多节段颈椎病43例疗效观察

Clinical application of unilateral open-door cervical expansive laminoplasty plus titanium miniplate fixation for multilevel cervical spondylotic myelopathy

目的评估颈椎后路单开门微型钛板固定椎板成形术治疗多节段颈椎病的临床应用价值。方法回顾性分析2011年1月至2012年9月在我科行颈椎后路单开门微型钛板固定椎板成形术的多节段脊髓型颈椎病患者43例,记录手术时间、术中出血量、JOA评分改善率、术后轴性症状发生率及严重程度;同时在随访的影像资料上测量术后脊髓后移距离、颈椎曲度指数改变及丢失程度、术后椎管扩大率及椎板开门角度。结果平均手术时间(107.1±16.3)min,术中平均出血量(200.0±28.7)ml,椎板开门角度为(48.0±3.1)°。术后椎管扩大率为(69.7±13.5)%;颈椎曲度指数较术前明显减少(P<0.01),丢失程度为(3.4±2.7)%;平均脊髓后移距离为(3.1±0.7)mm;术后JOA评分较术前明显增加(P<0.01)。JOA评分改善率与脊髓后移距离无明显相关性(r=0.161,P=0.301)。结论颈椎后路单开门微型钛板固定椎板成形术治疗多节段颈椎病操作简单,安全可靠,可避免开门后再关门;并可获得手术后即刻的稳定性,减少术后颈椎曲度的丢失和后凸畸形的发生率,术后神经功能恢复明显,是一种治疗多节段颈椎病的有效方法。

Objective To evaluate the clinical application of unilateral open-door cervical expansive laminoplasty plus titanium miniplate fixation for multilevel cervical spondylotic myelopathy. Methods From January 2011to September 2012, 43 patients of multilevel cervical spondylotic myelopathy treated with unilateral open-door cervical expansive laminoplasty plus titanium miniplate fixation were enrolled retrospectively in this study. The operation time, blood loss, Japanese Orthopaedic Association（JOA） scores and incidence of axial symptoms were recorded respectively. The imaging materials of clinical follow-up were used to measure and evaluate the posterior shifting of spinal cord, loss of cervical curvature, expansion rate of spinal canal and angle of the opened laminae. Results The average time of the operation was（107.1±16.3） min. The mean blood loss was（200.0±28.7） ml. The angle of opened laminae was 48.0°±3.1°. The postoperative expansion rate of spinal canal was（69.7±13.5）%. The cervical curvature index decreased significantly compared with preoperative cervical curvature index（P〈0.01）. The loss of cervical curvature was（3.4±2.7）%. The postoperative JOA scores increased obviously compared with the preoperative JOA scores（P〈0.01）. The mean posterior shifting of spinal cord was（3.1±0.7） mm. The improvement rates of JOA score have nothing to do with the posterior shifting of spinal cord（r=0.161,P=0.301）. Conclusion The unilateral open-door cervical expansive laminoplasty via titanium miniplate is safe and efficacious in the treatment of multilevel CSM, which can reduce the loss of cervical curvature and incidence rate of kyphosis, prevent reclose of opened laminae. Moreover,The postoperative neural function recovered obviously.