基于数字化CT的颈椎单开门术C_7椎的应用解剖学研究

An Applied Anatomy Research of Digital-CT-based Unilateral Open-door Cervical Expansive Laminoplasty of C_7

目的探讨应用Centerpiece微型钢板行颈后路单开门椎管扩大成形术的早期临床效果,并借助数字化CT的方法探究颈椎单开门手术中C7椎最佳的开槽数据,为精确化手术提供参考。方法回顾性分析2013年2月至11月在四川大学华西医院进行手术治疗的颈椎单开门椎板成形Centerpiece内固定术患者。比较患者术前和术后各随访时点的神经功能评估结果(JOA评分)、颈椎曲度指数、Pavlov值、椎管横截面积及不同位置、角度、深度C7椎板开槽数据的差异。结果共纳入58例患者,其术后JOA评分明显高于术前,且差异有统计学意义(9.4±2.9vs.14.7±2.6,t=11.417,P=0.000)。末次随访时椎管矢状径(21.3±2.1 mm vs.9.7±2.1 mm,t=27.737,P=0.000)、Pavlov值(0.92±0.13 vs.0.44±0.12,t=30.621,P=0.000)及椎管横截面积(276±37 mm2 vs.129±25 mm2,t=32.104,P=0.000)明显大于术前,且差异均有统计学意义,而末次随访时颈椎曲度指数与术前相比差异有统计学意义(11.2±11.5 vs.9.3±11.7,t=–1.713,P=0.000)。C7椎板开门侧理想开槽位置和角度与手术实际开槽位置和角度比较,差异均有统计学意义(P均<0.05);C7椎板铰链侧理想开槽位置和角度与手术实际开槽位置和角度比较,差异无统计学意义(P均>0.05),但理想开槽深度与手术实际开槽深度比较,差异有统计学意义(P<0.05)。结论 Centerpiece微型钢板应用于颈后路单开门椎板成形术的椎板固定无螺钉松动和钢板断裂,能有效维持椎板的开门状态,防止再关门的发生;患者术后神经功能恢复良好,临床效果佳。

Objective To explore early clinical effects of Centerpiece-based unilateral open-door cervical expansive laminoplasty plus centerpiece titanium minitype plate fixation, to research the data of the best slotting in the CT-based open-door cervical operation and to provide the reference for accurate operation. Methods A retrospective analysis of the patients who had received Centerpiece-based unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation from West China Hospital of Sichuan University from February 2013 to November 2013 were performed. The neurological function assessment results （]OA score）, cervical curvature indexhave, Pavlov value, spinal canal cross-sectional area and different position, angle and depth of C7 lamina slotting data of all patients before and after the operation were all analyzed and compared. Results A total of 58 patients were included. The postoperative JOA score was significantly higher than that of the preoperative （9.4＋2.9 vs. 14.7＋2.6, t=11.417, P=0.000）. The sagittal diameter of vertebral canal （21.3＋2.1 mm vs. 9.7＋2.1 mm, t=27.737, P=0.000）, Parlor value （0.92＋0.13 vs. 0.44＋0.12, t=30.621, P=0.000）, and spinal canal cross-sectional area （276＋37 mm2 vs. 129＋25 ram% t=32.104, P=0.000） at the end of the last follow-up were significantly greater than those of preoperative. When comparing the last follow-up with preoperative, cervical curvature index showed significant difference （11.2＋11.5 vs. 9.3＋11.7, t=-1.713, P=0.000）. Significant differences were found in the comparison of the ideal position and angle of the open door of the C7 lamina and the angle and position of the operation （all P values 〈0.05）; when comparing the position and angle of the ideal position and angle of the Cr lamina hinge with that of the actual operation, no significant differences were found （all P values 〉0.05）; but when comparing the ideal depth with the actual depth of the operation, a significant difference was found （P〈0.05）. Conclusion Centerpiece micro plate used in posterior cervical expansive open-door laminoplasty forming operation of laminectomy fixed screw loosening and plate breakage, can effectively maintain the lamina in the open state, and prevent it to be closed. The patients have good recovery of nerve function after operation and the clinical efficacy is good.