微型钛板在颈椎后路椎板成形中的应用:近期随访

Application of titanium miniplate to posterior cervical laminoplasty:a short-term follow-up

背景:颈椎后路单开门椎管扩大成形术治疗多节段颈椎病时,椎管发生再狭窄、颈椎生理曲度的丢失、轴性症状的发生是影响疗效的重要原因,持久维持椎管的扩大状态和减少颈椎后部组织结构的干扰在临床治疗中非常有必要。目的:观察微型钛板置入内固定在颈椎后路单开门椎管扩大成形治疗过程中的临床效果及近期随访结果。方法:回顾性分析厦门大学附属中山医院2006年4月至2013年4月具有完整资料的采用颈椎后路单开门椎管扩大成形术治疗脊髓型颈椎病的患者共67例,其中微型钛板组27例使用微型钛板置入内固定,缝线组40例采用传统缝线悬吊"门轴"。两组的减压节段均为C3-7。比较两组手术时间、术中出血量、随访时JOA评分改善率、颈椎曲度变化值、轴性症状及椎板掀开角度。结果与结论:两组手术时间、术中出血量、JOA评分改善率差异均无显著性意义(P>0.05)。两组曲度变化值,术后6个月微型钛板组颈椎曲度丢失不明显,缝线组颈椎曲度部分丢失(P<0.05),两组差异有显著性意义(P<0.05)。术后6个月轴性症状发生率微型钛板组明显低于缝线组(P<0.05)。末次随访时椎板开门角度微型钛板组(35.2±6.2)°与缝线组(34.0±4.7)°比较差异无显著性意义(P>0.05)。提示颈椎后路单开门椎管扩大成形治疗脊髓型颈椎病,使用微钛板与传统缝线悬吊固定方法,均能获得较好的临床效果,但微型钛板固定法能减轻术后的轴性症状以及防止颈椎曲度丢失。

BACKGROUND：During cervical posterior expansive open-door laminoplasty for multisegmental cervical spondylosis, spinal canal restenosis, loss of cervical lordosis, and axial symptoms are the important factors affecting curative effects. It is very necessary to maintain spinal canal expanded state and to reduce interference of the posterior cervical structure in the clinical treatment. OBJECTIVE：To observe clinical outcomes and short-term fol ow-up effect of posterior expansive open-door laminoplasty via titanium miniplate in treatment of cervical spondylotic myelopathy. METHODS：A total of 67 patients with cervical spondylotic myelopathy who underwent posterior expansive open-door laminoplasty at the Zhongshan Hospital, Xiamen University from April 2006 to April 2013 were retrospectively analyzed. Titanium miniplate group （n=27） received titanium miniplate fixation. Suture group （n=40） received traditional suture suspension. Al patients had decompression ranged from C 3-7 . Operation time, intraoperative blood loss, improvement rate of Japanese Orthopedic Association score during fol ow-up, value of cervical curvature, axial symptoms, and lamina opened angle were compared between the two groups. RESULTS AND CONCLUSION：No significant difference in operation time, intraoperative blood loss and improvement rate of Japanese Orthopedic Association score was detectable between two groups （P〉0.05）. Cervical curvature changes in both groups：loss of cervical curvature at 6 months postoperation was not significant in the titanium miniplate group, but cervical curvature partial y lost in the suture group, and significant differences in the cervical curvature were detected between the two groups （P〈0.05）. The incidence of axial symptoms was significantly lower in the titanium miniplate group than in the suture group at 6 months after surgery （P〈0.05）. During final fol ow-up, no significant difference in the lamina open-angle was detected between titanium miniplate group （35.2±6.2）° and suture group （34.0±4.7）° （P〉0.05）. These data suggested that posterior expansive open-door laminoplasty for treatment of cervical spondylotic myelopathy using both titanium miniplate and suture methods can obtain good clinical outcomes. However, titanium miniplate fixation can relieve postoperative axial symptoms and prevent loss of cervical curvature.