单开门椎管扩大椎板成形术联合侧块螺钉治疗脊髓型颈椎病伴颈椎不稳

Cervical single open door laminoplasty with lateral mass screw fixation for the treatment of cervical spondylotic myelopathy with cervical instability

目的：探讨单开门椎管扩大椎板成形术联合侧块螺钉治疗脊髓型颈椎病伴颈椎不稳的疗效.方法：2010年3月至2012年10月,采用单开门椎管扩大椎板成形术联合侧块螺钉治疗脊髓型颈椎病伴颈椎不稳患者25例,其中男18例,女7例;年龄57～68岁,平均57岁.记录术前及末次随访时的JOA评分,对患者临床症状改善进行分析.同时记录Cobb角及颈椎活动度,分析颈椎退变程度.结果：33例患者均获随访,时间18～36个月,平均25.6个月.出现脑脊液漏1例,切口脂肪液化1例,C5神经根麻痹4例,JOA评分由术前的5.2±2.1增加至末次随访时的11.3±2.4 （P＜0.05）,Cobb角由术前的（6.5±3.4）°提升至末次随访时的（13.2±4.9）°（P＜0.05）.颈椎活动度由术前的（30.4±9.2）°下降至末次随访时的（26.5±8.7）°（P＜0.05）.结论：单开门椎管扩大椎板成形术联合侧块螺钉治疗脊髓型颈椎病伴颈椎不稳疗效良好,具有适用范围广、牢固等优点,但要减少并发症的发生.

Objective：To evaluate the outcomes of single open-door laminoplasty with lateral mass screw fixation in treating cervical spondylotic myelopathy （CSM） with cervical instability.Methods：From March 2010 to October 2012,25 patients with spondylotic myelopathy and cervical instability underwent single open-door laminoplasty with lateral mass screw fixation.There were 18 males and 7 females,aged from 57 to 68 years with the mean of 57 years.Japanese Orthopaedic Association （JOA） scores were used to evaluate clinical effects before operation and final follow-up.Radiographical measures were made in change of Cobb angle by sagittal plane from C2 to C7,and cervical range of motion.Results：All the patients were followed up from 18 to 36 months with an average of 25.6 months.Cerebrospinal fluid leakage occurred in 1 case,incision fat necrosis in 1 case,C5 nerve root palsy in 4 cases.JOA scores was improved from preoperative 5.2±2.1 to 11.3±2.4 final follow-up.Cobb angle was changed from preoperative （6.5±3.4）° to （13.2±4.9）° final follow-up.Cervical range of motion was changed from preoperative （30.4±9.2）° to （26.5±8.4）° final follow-up.Conclusion：As an effective treatment to CSM with cervical instability,single open-door laminoplasty with lateral mass screw fixation has the advantage of extensive application scope,safety and steady,but the incidence rate of complication must be reduced.