Y型纳米骨板单开门椎管成形术治疗多节段脊髓型颈椎病的疗效分析

Efficacy of treating multilevel cervical spondylotic myelopathy with single-door laminoplasty via Y type nano-bone plate

目的探讨Y型纳米骨板单开门颈椎管扩大成形术(EOLP)在治疗多节段脊髓型颈椎病(MCSM)中的应用价值,并作近期疗效分析。方法自2013年1月至2016年12月应用Y型纳米骨板EOLP治疗MCSM患者79例,以日本矫形外科协会(JOA)评估系统评价术后神经功能的改善情况;测量术前及术后6个月颈椎X线的颈椎曲度变化及C5椎管矢状径,了解椎管维持和扩大情况;利用术前、术后颈椎MRI评价脊髓受压改善程度;借助三维螺旋CT观察开门侧及门轴侧的骨愈合情况。结果随访6~36个月,平均(20.4±7.9)个月。术前JOA评分为(8.6±1.3)分,术后6个月为(14.3±1.5)分(P<0.05),JOA改善率为(68.6±15.8)%;术后随访X线片及三维螺旋CT示椎管扩大满意,门轴侧均骨性愈合,开门侧骨质愈合不明显,均未见椎板塌陷和再关门现象;术前C5节段椎管矢状径为(8.9±1.1)mm,术后6个月为(15.1±1.1)mm,差异有统计学意义(P<0.05),椎管扩大率为(70.8±22.3)%;术前颈椎曲度为(14.8±7.0)°,术后为(15.1±6.7)°,差异无统计学意义(P>0.05)。结论 Y型纳米骨板EOLP在MCSM中应用安全、有效,不仅提供了良好的即刻固定,也为后期开门侧骨性融合提供了可能。

Objective To explore the application value of single-door laminoplasty via Y type nano-bone plate in treating multilevel cervical spondylotic myelopathy （MCSM） and analyze the short-term efficacy. Methods From January 2013 to December 2016, 79 cases of MCSM were treated with single-door laminoplasty via Y type nano-bone plate to evaluate the improvement of post-operative neurological function by the Japanese Orthopaedic Association （JOA） evaluation system. We also measured cervical curvature of cervical X-ray and C5 sagittal diameter of the spinal canal before operation and 6 months after operation to understand the maintenance and enlargement of the spinal canal. The improvement degree of spinal cord compression was evaluated by preoperative and postoperative cervical MRI. Osseous healing on the open door side and the door shaft side was observed with the aid of three-dimensional spiral CT. Results Follow-up ranged from 6 to 36 months, with an average of （20.4±7.9） months. Preoperative JOA score was （8.6 ± 1.3） points and JOA score 6 months after operation was （14.3 ± 1.5） points （P 〈 0. 05）. JOA improvement rate was （68. 6 ± 15. 8）% i postoperative follow-up X-ray and three- dimensional spiral CT showed that the spinal canal had satisfying enlargement, the door shaft side all had osseous healing, the open door side osseous healing was not obvious, and there was no lamina collapse or reclosing. Sagittaldiameter of the C5 spinal canal was （8.94±1.1）mm before operation and （15.1±1.1）mm 6 months after operation （P〈 0.05）. The spinal canal enlargement rate was （70. 8 ± 22. 3）%, cervical curvature was （14. 8± 7. 0）° preoperatively and （15.1±6.7）°postoperatively with no significant difference （P〉0.05）. Conclusion EOLP via Y type nano-bone plate is safe and efficacious in treating MCSM. It not only provides a good immediate fixation, but also provides the possibility for the open door side lateral osseous fusion.