微型钛板内固定联合伸肌附着点重建椎管成形术治疗累及C_2节段脊髓型颈椎病的效果分析

Titanium plate fixation combined with extensor attachment point reconstruction for cervical spondylotic myelopathy involving C2 segment

目的观察微型钛板内固定联合伸肌附着点重建单开门椎管扩大成形术治疗累及C_2节段脊髓型颈椎病的临床疗效。方法回顾性分析自2014-02—2016-11诊治的21例累及C_2节段脊髓型颈椎病,行单开门椎管扩大成形微型钛板内固定联合伸肌群附着点重建术。观察术后患者神经功能恢复、颈椎曲度改变、颈后肌群萎缩及轴性症状发生的情况。结果 21例均获得随访,随访时间平均15.8(13～18)个月。术后3个月JOA评分较术前明显提高,差异有统计学意义(P <0.05);而末次随访时JOA评分与术后3个月比较差异无统计学意义(P>0.05)。术前、术后3个月、末次随访时颈椎曲度指数比较差异无统计学意义(P>0.05)。末次随访时C_2矢状径长度由术前(9.1±2.3)mm增至(14.6±3.4)mm,差异有统计学意义(P <0.05)。末次随访时颈后肌群横截面积与术前比较差异无统计学意义(P>0.05)。术后轴性症状评定结果:优11例,良7例,可2例,差1例,轴性症状发生率为14.3%。结论单开门椎管扩大成形微型钛板内固定术是治疗累及C_2节段脊髓型颈椎病的有效术式,能够显著促进神经功能恢复,钛板内固定可增强颈椎稳定性,重建伸肌附着点可以减轻颈后肌群的萎缩程度,从而降低后凸畸形及轴性症状的发生率。

Objective To observe the effect of titanium plate fixation combined with extensor attachment point reconstruction for the treatment of cervical spondylotic myelopathy(CSM) involving C2 segment. Methods From February 2014 to November 2016, 21 patients with CSM involving C2 segment underwent open-door laminoplasty with titanium plate fixation and extension muscle attachment reconstruction. The postoperative neurological recovery, cervical curvature index, atrophy of the back muscles and axial symptoms were recorded and analyzed. Results All patients were followed up for an average of15.8 months(arrange 13-18 months). The JOA score was significantly improved at 3 months after operation( P <0.05), but there was no significant difference at the final follow-up and 3 months after surgery(P >0.05). The cervical curvature index sustained well at 3 months after surgery and at final follow-up compared with the preoperative level( P >0.05). The C2 sagittal diameter increased from(9.1±2.3) mm preoperatively to(14.6±3.4) mm postoperatively(P <0.05). The cross-sectional area of the posterior cervical muscle had no significant reduction at final follow up(P >0.05). The axial symptoms occurred in three patients(14.3%). Based on the axial symptom criterion, the result was excellent in 11 patients, good in 7, fair in 2, and poor in 1, the incidence of axial symptoms was 14.3%. Conclusion Laminoplasty with titanium plate fixation and extensor attachment point reconstruction is effective for CSM involving C2 segment, which reduce the atrophy of the posterior cervical muscles, avoid the occurrence of kyphotic deformity and decrease the occurrence of axial symptoms.