Neulen钛板置入并椎管扩大植骨治疗颈椎病:半年随访钛板周围植骨愈合率

Neulen titanium plate fixation and spinal canal expansion bone grafting for cervical spondylosis: half-year follow-up of healing rate of bone graft

背景:传统的颈椎病单开门手术治疗,大多采用缝线悬吊等门轴侧固定的方法来维持椎板处于开门状态,其固定效果不太理想。目的:分析Neulen钛板置入内固定并开门侧植骨治疗不同类型颈椎病患者的临床应用效果。方法:颈椎后路单开门椎管扩大成形,采用Neulen钛板置入内固定并于开门侧植骨治疗32例患者。结果与结论:32例颈椎病患者均获得6个月以上随访。患者神经功能改善明显,JOA评分由治疗前(8.7±3.6)分提高至治疗后(14.6±2.4)分,改善率为(63.3±8.9)%(P<0.05)。治疗后6个月随访X射线及CT显示门轴侧缝隙消失,CT部分层面可见开门侧植骨愈合有类似于骨性椎板存在,显示椎管扩大满意,均未见内固定物松动、断裂、移位及再关门的现象。结果表明颈椎后路单开门治疗中应用Neulen钛板置入内固定并开门侧植骨,能有效维持椎板开门状态,钛板周围植骨融合率78%。钛板两端的叉形设计使得较少的螺钉即可达到较高的生物力学稳定性;钛板固定后能够达到对开门侧形成真正的刚性支撑而非弹性固定,使门轴侧形成牢固的即刻稳定,使得门轴侧更容易骨性愈合。

BACKGROUND：In traditional single open door surgery for cervical spondylosis, door shaft fixation such as suture suspension was used to maintain the open status of vertebral plate, but the fixation effect was not ideal. OBJECTIVE：To probe into the clinical application of Neulen titanium plate instrument and open-door bone grafting in patients with different types of cervical spondylosis. METHODS： A total of 32 patients were treated with Neulen titanium plate instrument and open-door bone grafting in unilateral open-door laminoplasty. RESULTS AND CONCLUSION：A total of 32 patients with cervical spondylosis were folowed up for at least 6 months. Neurological function of these patients improved significantly. JOA score improved from （8.7±3.6） to （14.6±2.4）, with an improvement rate of （63.3±8.9）% （P 〈 0.05）. In folow-up at 6 months after treatment, X-ray and CT revealed that pivot side crack had disappeared, and spinal canal expansion was satisfactory. No loose, breakage, displacement or re-closing appeared. Results suggested that Neulen titanium plate fixation or open-door side bone grafting could maintain opening state in treatment using cervical posterior single door. Fusion rate of bone graft surrounding titanium plate was 78%. Fork design of both sides of titanium plate made less screws achieve high biomechanical stability. Titanium plate fixation obtained rigid support, but not elastic fixation on the door open side, obtained immediate stability of door shaft side, and easily resulted in bone fusion.