单开门椎管扩大成形微型钢板固定术后椎板铰链侧不同程度骨折的断端骨愈合对比

A comparative study of the bony fusion in different degrees of vertebral plate hinge fracture after single open-door cervical expansive laminoplasty with centerpiece mini-plate fixation

目的对比颈椎单开门椎管扩大成形微型钢板固定术后椎板铰链侧不同程度骨折的断端骨愈合情况。方法回顾性分析2010年1月至2012年12月采用颈椎单开门椎管扩大成形微型钢板固定术治疗的79例患者的临床资料。根据术后CT扫描结果，将椎板铰链侧骨折分为不完全骨折和完全骨折。完全骨折分为四型：Ⅰ型，骨折断端无移位或分离；Ⅱ型，骨折断端部分移位或分离；Ⅲ型，骨折断端完全移位或分离；Ⅳ型，骨折断端向椎管内移位或塌陷。观察椎板铰链侧骨折愈合情况并比较不同类型骨折愈合率的差异。结果随访12～45（21．2±5．6）个月。术后1周CT扫描395个节段，椎板铰链侧完全骨折占58．2％（230/95）；其中Ⅰ型占66．1％（152／230），Ⅱ型占25．7％（59／230），Ⅲ型占6．5％（15／230），Ⅳ型占1．7％（4／230）。术后6个月不完全骨折的骨性愈合率为97．6％（161／165），高于完全骨折的80．9％（186／230），差异有统计学意义（P〈0．05）。术后3，6个月不同类型完全骨折骨性愈合率比较差异均有统计学意义（P〈0．05），Ⅲ型完全骨折术后骨性愈合率最低。结论椎板铰链侧完全骨折以Ⅰ型为主，完全骨折的骨性愈合率低，Ⅲ型完全骨折术后骨性愈合率最差。

Objective To compare the bony fusion in different degrees of vertebral plate hinge fracture after single open-door cervical expansive laminoplasty with centerpiece mini-plate fixation. Methods The clinical data of 79 patients received the unilateral simple open-door cervical expansive laminoplasty with centerpiece mini-plate fixation from January 2010 to Deeember 2012 were retrospectively analyzed. The vertebral plate hinge fracture was divided into incomplete fracture and complete fracture according to the postoperative CT scan. The complete fracture was divided into four types：type I in which there was no displacement;type II in which there was mild to moderate displacement;type III in which there was complete displacement or separated; type IV in which there was hinge＇ s collapse into cervical canal. The hinge fracture healing was observed and the difference of different types of fracture healing rate was compared. Results Follow-up of 12 - 45 （21.2 ± 5.6） months.CT scan found 395 segments 1 week after the operation,vertebral plate hinge complete fracture accounted for 58.2% （230/395）. And type I accounted for 66.1% （152/230）, type II accounted for 25.7%（59/230）,type III accounted for 6.5%（15/230） and type lVaccounted for 1.7% （4/230）. The fusion rate of incomplete fracture at 6 months after the operation was higher than that complete fracture [ 97.6% （ 161/165 ） vs. 80.9% （ 186/230 ） ], there was significant difference （P 〈 0.05 ）. The fracture rate in different types of complete fracture at 3,6 months after the operation had significant difference （P 〈 0.05）. Type III fracture had the lowest healing rate. Conclusion Type I fracture is the major type for vertebral plate hinge complete fracture, complete fracture get a relatively bad bony fusion and type II fracture has the lowest healing rate.