颈后路单开门微型钢板内固定术治疗多节段重症型颈椎病

Clinical application of cervical posterior open-door laminoplasty and mini-plate internal fixation in the treatment of multilevel cervical spondylosis

目的 探讨颈后路单开门微型钢板内固定术治疗多节段重症型颈椎病的临床疗效.方法 对28例多节段重症型颈椎病患者行C3 ～ C7单开门微型钢板内固定术治疗,其中男23例,女5例,平均年龄（65.7±2.3）岁.21例为多节段颈椎间盘突出,5例为后纵韧带长节段骨化,2例为颈椎管发育性狭窄.术后神经功能改善情况采用日本骨科协会评估治疗分数（JOA）及其改善率评价.结果 手术时间为（150 ±20） min,出血量为（200±40） ml,术中术后未出现并发症.随访6 ～12个月,平均9个月,术前JOA评分为（7.2±0.8）分,术后JOA评分为（14.9±1.3）分,改善率为（77±6）％;术前术后JOA评分差异有统计学意义（P＜0.01）,术后6个月复查颈椎X线提示门轴均达骨性融合,稳定性良好,未见关门及神经损伤加重.结论 颈椎后路单开门微型钢板内固定术治疗多节段重症型颈椎病可减少术后轴性疼痛,防止再关门,临床疗效满意.

Objective To investigate the clinical curative effect of cervical posterior open-door laminoplasty and mini-plate internal fixation in the treatment of multilevel cervical spondylosis.Methods From August 2013 to August 2014,28 cases of severe cervical spondylosis were treated with C3 to C7 posterior open-door laminoplasty and mini-plate internal fixation,including 23 males and 5 females,with average age of 65.7 years old （ranging from 55 to 77）.There were 21 cases of multilevel cervical disc herniation,5 cases of long segment ossification of posterior longitudinal ligament,and 2 cases of developmental cervical spinal canal stenosis.Japanese Orthopaedic Association （JOA） score was applied to evaluate neurological improvement postoperatively.Results The operation time was （150 ± 20） min,the bleeding volume was （200 ± 40） ml,and no intraoperative and postoperative complications occurred.The average follow-up period was 9 months （ranging from 6 to 12）.The preoperative JOA score was （7.2 ±0.8） points and that postoperation was （14.9 ± 1.3） points with the remission rate being （77 ± 6） ％ （P ＜ 0.01）.Six months post-operation,the cervical spine X-ray image revealed that door spindle has reached bony fusion and good stability was acquired,without door being closed or worse nerve damage.Conclusion The application of cervical posterior open-door laminoplasty and mini-plate internal fixation in the treatment of multilevel cervical spondylosis can reduce the axial pain,prevent the hinge side lamina fracture and acquire satisfied clinical efficacy,which is a simple and safe surgical method.