颈椎后路单开门leverage钛板固定术治疗多节段脊髓型颈椎病的疗效研究

Combined use of posterior unilateral open-door laminoplasty and leverage fixation for treatment of multi-segmental cervical spondylotic myelopathy

目的探讨颈椎管单开门椎管扩大成形术及leverage固定治疗多节段脊髓型颈椎病的临床疗效。方法回顾2011年3月至2015年5月期间,武警总医院骨三科采用颈椎管单开门椎管扩大成形leverage固定术治疗多节段脊髓型颈椎病的患者25例,男性16例,女性9例,年龄（60.6±9.9）岁。所有患者随访时均行X线、CT及MRI检查,记录随访时患者临床症状及体征变化,并进行相应的资料分析研究,使用日本骨科协会（Japanese Orthopaedic Association,JOA）评分及颈肩疼痛视觉模拟评分（Visual Analogue Scale,VAS）方法,对术前、术后神经功能改善情况、颈椎曲度以及颈椎管变化进行评分记录。结果随访6-24个月,25例患者神经功能均得到明显改善,术前JOA评分（10.16±1.35）与术后评分（14.28±1.15）差异有统计学意义（P〈0.05）,平均改善率61.24%。术前、后颈椎曲度无明显变化（术前17.15°±6.25°;术后17.93°±5.75°）,差异无统计学意义（P〉0.05）。术前VAS评分（6.68±1.12）与术后（2.32±0.84）差异有统计学意义（P〈0.05）。术前及末次随访C5椎管矢状径分别为（9.22±2.01）和（15.64±2.08）mm,差异有统计学意义（P〈0.05）,椎管平均扩大率为（73.92±25.49）%。随访期间,25例患者均未发现内固定松动、断裂及再关门现象。结论 leverage微型钛板能有效维持椎管的扩大状态,神经症状改善明显,同时可维持颈椎曲度,较小影响颈椎运动功能,可减轻术后颈部轴性症状的发生率,临床应用疗效较好。

Objective To evaluate the clinical efficiency of posterior unilateral open-door laminoplasty and leverage titanium plate internal fixation in the treatment of cervical spondylotic myelopathy（ CSM） with multi-segmental spinal stenosis. Methods Between Mar 2011 and May 2015,25 patients with multi-segmental CSM with multi-segmental spinal stenosis were treated by posterior unilateral open-door laminoplasty and leverage fixation. There were 16 males and 9females,whose mean age was 60. 6 ± 9. 9 years during the surgery. The change of clinical symptoms and signs was recorded during follow-up,and they all received X-ray and MRI. In all the patients,the preoperative and postoperative neurological function,the cervical curvature,cervical vertebra tube volume and axial symptoms were measured,recorded and analyzed.There was statistically significant difference（ P〈 0. 05） in the mean Japanese Orthopaedic Association（ JOA） score,and Visual Analogue Scale（ VAS）. Results All the 25 patients were followed up for more than 6 months（ 6- 24 months）. No symptoms of C5 nerve root were found in our series. According to the JOA score and VSA score,the neurological functions of each patient were significantly improved. The preoperative JOA score was 10. 16 ± 1. 35 and the improvement rate 61. 24%.There was statistically significant difference between the preoperative VSA score and the postoperative one（ 6. 68 ± 1. 12 vs2. 32 ± 0. 84）（ P 〈0. 05）. The preoperative and postoperative meansurement of the spinal vertebrai canal diameter was（ 9. 22 ± 2. 01） and（ 15. 64 ± 2. 08） mm,respectively,so there was statistically significant difference（ P 〈0. 05）,indicating that the cavical spinal canal was increased after operation. Conclusion Leverage titanium plate internal fixation can effectively help maintain the expanded vertebral canal after unilateral open-door laminoplasty,reduce the incidence of postoperative axial symptoms,and maintain the cervical physical curvature.