保留颈后方韧带复合体的单开门微型钛板固定椎管成形术治疗脊髓型颈椎病的临床效果

Clinical efficacy of expansive open-door laminoplasty with mini titanium plate fixation and reservation of cervival posterior ligamentous complex for treatment of cervical spondylotic myelopathy

目的 探讨保留颈后方韧带复合体的单开门微型钛板固定椎管成形术治疗脊髓型颈椎病的临床效果。方法 36例多节段脊髓型颈椎病患者,均接受保留颈后方韧带复合体的单开门微型钛板固定椎管成形术治疗。于术前、术后3个月及末次随访时采用日本骨科协会（JOA）脊髓损害评分表评估手术疗效,计算JOA评分神经功能改善率,术后3个月观察轴性症状发生情况,术前及末次随访时采用X线测量颈椎曲度指数（CCI）。结果 所有患者均顺利完成手术,未出现脊髓及神经损伤情况。随访时间为13~46个月,随访过程中无内固定物松动、折断及“再关门”出现。患者术前、术后3个月及末次随访时的JOA评分分别为（8.2±2.5）分、（13.0±3.3）分和（13.9±3.6）分,JOA评分随观察时间延长而升高（P〈0.05）,末次随访时JOA评分神经功能改善率为（64.8±18.5）%。术前CCI为（16.2±4.5）%,末次随访时减小为（14.7±4.7）%,CCI较术前减少（1.5±0.4）%。13.9%（5/36）的患者术后出现轴性症状。结论 保留颈后方韧带复合体的单开门微型钛板固定椎管成形术能有效促进脊髓型颈椎病患者神经功能的恢复,在维持颈椎曲度的同时,可降低术后轴性症状的发生。

Objective To investigate the clinical efficacy of expansive open-door laminoplasty with mini titanium plate fixation and reservation of cervical posterior ligamentous complex for the treatment of cervical spondylotic myelopathy （CSM）. Methods Thirty-six patients with multi-segment CSM were selected and underwent expansive open-door laminoplasty with mini titanium plate fixation and reservation of cervical posterior ligamentous complex. Before treatment,after 3 months of treatment and during the last fallow-up,the surgical efficacy was assessed using Japanese Orthopaedic Association （JOA） spinal injury scale, then the neurological function improvement rate of JOA score was calculated. After 3 months of treatment, the incidence of axial symptom was observed. Before treatment and during the last follow-up,cervical curvature index（CCI） was measured by X-ray examination. Results The surgery was completed successfully in all cases. No spinal cord and nerves injuries occurred. During the follow-up of 13 -46 months, no internal fixation loosening/breaking or close-door for a second time was observed. The JOA scores before treatment, after 3 months of treatment and during the last follow-up were （ 8.2 ±2.5 ）, （ 13.0 ± 3.3 ） and （ 13.9 ± 3.6 ） points, the JOA scores increased over the observation time （ P 〈 0. 05）. The neurological function improvement rate of JOA score was （64.8 ± 18.5）% during the last follow-up. CCI was （16.2 ± 4.5 ）% before surgery and decreased to （14.7 ± 4.7）% during the last follow-up,and the loss of CCI was （ 1.5 ±0.4） % compared to the preoperative. The axial symptoms occurred in 13.9% （5/36） of the patients after surgery. Conclusion Expansive open-door laminoplasty with mini titanium plate fixation and reservation of cervical posterior ligamentous complex can effectively promote the recovery of neurological function in patients with CSM, and reduce the postoperative incidence of axial symptom while maintaining the cervical curvature.