颈椎单开门微型钛板固定成形术中不同开门角度对多节段脊髓型颈椎病疗效的影响

Efficacy of different angles in open-door expansive laminoplasty in treatment of multi-segmental cervical spondylosis myelopathy

目的探讨颈后路单开门微型钛板固定椎管扩大成形术后不同椎板开门角度对多节段脊髓型颈椎病疗效的影响。方法我院2008-01-2010-05共63例多节段脊髓型颈椎病患者采用颈后路单开门微型钛板固定椎管扩大成形术治疗,所有患者术后3个月均行CT扫描,测得椎板开门角度的大小为24.5°-49.0°,以中位数36.5°为界限将患者分为两组：A组33例,椎板开门变化角度24.5°-36.5°;B组30例,椎板开门变化角度36.6°-49.0°。术后评估两组脊髓功能改善（JOA评分）、颈椎曲度指数丢失及颈部轴性症状发生情况。结果所有手术均顺利完成,两组患者手术时间、出血量比较差异无统计学意义（P〉0.05）。术后两组患者JOA评分均较术前有明显提高（P〈0.05）,组间比较差异无显著性（P〉0.05）;末次随访时,两组颈椎曲度指数（CCI）较术前均有明显丢失（P〈0.05）;组间比较差异无显著性（P〉0.05）;A组有18.2%的患者术后出现轴性症状,B组为26.7%,差异具有统计学意义（P〈0.05）。结论颈后路单开门微型钛板固定术后开门角度大小与脊髓功能改善无明显关系,但开门角度过大会增加轴性症状的发生率。

Objective To investigate the effect of different angles in open-door expansive laminoplasty on efficacy of patients with multi-segmental cervical spondylosis myelopathy. Methods All of 63 patients with multi-segmental cervical spondylosis myelopathy undrewent laminoplasty with mini-plate from January 2008 to May 2010. Based on the angles of the open-door,they were divided into two groups： 24. 5°- 36. 5° group（ n = 33） and 36. 6°- 49. 0° group（ n = 30）. The spinal cord function,cervical curvature index,and axial symptoms were recorded and compared. Results All surgeries succeeded without spinal cord and nerve injury. There was no significant difference in operation time and blood loss between the two groups（ P〈0. 05）. After the surgery,JOA score significantly increased in both groups（ P〈0. 05）,but there was no significant difference between the two groups（ P〈0. 05）. At the last follow-up,the cervical curvature index was significantly higher than that before surgery in both groups（ P〈0. 05）. The occurrence rate of axial symptoms was 18. 2% in 24. 5°- 36. 5° group and 26. 7% in 36. 6°- 49. 0° group（ P〈0. 05）. Conclusion During the procedure of cervical laminoplasty,the angles of open-door has no relationship with the improvement of spinal cord function. But the bigger angle of door open is,the higher incidence of axial symptoms will happen.