两种固定方法在颈椎单开门椎管扩大椎板成形术中的比较研究

Comparative study of two fixation methods for unilateral open-door cervical laminoplasty

目的通过对门轴侧锚定法与开门侧支撑法两组病例的比较研究,评价纳米仿生骨"Y"形板在颈椎后路单开门椎管扩大椎板成形术中的应用价值。方法 2013年1月—2015年6月,本院收治椎管狭窄症(29例)和后纵韧带骨化症(OPLL,13例)颈椎后路手术适应证患者42例,均经后路行单开门椎管扩大椎板成形术,按手术时间顺序交替采用纳米仿生骨"Y"形板固定开门侧(A组,21例)及锚定法改良单开门(B组,21例)。记录手术时间、术中出血量及并发症发生情况。以颈椎功能障碍指数(NDI)及疼痛视觉模拟量表(VAS)评分评价患者手术前后生活质量;在术后即刻及末次随访的CT片上测量椎板掀开角度;在术前及末次随访CT片上测量C5节段椎管矢状径,椎管扩大率=(术后椎管矢状径-术前椎管矢状径)/术前椎管矢状径×100%。结果全部病例均获随访,随访时间12~24个月,平均16.5个月。2组患者手术时间、术中出血量及并发症发生情况差异无统计学意义(P>0.05)。2组患者术前NDI、VAS评分、椎板掀开角度及C5节段椎管矢状径差异无统计学意义(P>0.05)。A组末次随访时NDI、VAS评分及C5节段椎管矢状径与术前相比,差异有统计学意义(P<0.05);椎管扩大率51.1%;末次随访时椎板掀开角度与术后即刻相比,差异无统计学意义(P>0.05)。B组末次随访时NDI、VAS评分及C5节段椎管矢状径与术前相比,差异有统计学意义(P<0.05);椎管扩大率48.4%;末次随访时椎板掀开角度与术后即刻相比,差异有统计学意义(P<0.05)。末次随访时,2组间NDI、VAS评分及C5节段椎管矢状径差异无统计学意义(P>0.05);椎板掀开角度差异有统计学意义(P<0.05)。结论两种固定方式在颈椎后路单开门椎管扩大椎板成形术中均获满意的近期临床疗效。纳米仿生骨"Y"形板的应用能够更好地防止"再关门"现象发生,是一种安全、简便的方案,可作为微型钛板固定的补充。

Objective To investigate the outcomes of posterior cervical unilateral open-door laminoplasty based on 2 fixation methods for evaluating the application value of bionic nano-bone Y-plate in unilateral open-door cervical laminoplasty. Methods From January 2013 to June 2015,42 patients（spinal stenosis 29 cases and ossification of posterior longitudinal ligament 13 cases） undergoing posterior cervical unilateral open-door laminoplasty were followed up. These patients were equally divided into 2 groups ：group A received laminoplasty by bionic nano-bone Y-plate and group B by silk thread suspension. The operation time,blood loss and complications were recorded. The neck disability index（NDI） and the pain visual analogue scale（VAS） score were used to assess the quality-of-life of the patients before and after operation. The opened laminae angle was measured on CT immediately post-operation and at final follow-up. The sagittal diameter of C5 spinal canal was also calculated on CT at pre-operation and final follow-up. The spinal canal expansion rate=（postoperative sagittal diameter of spinal canalpreoperative sagittal diameter of spinal canal）/preoperative sagittal diameter of spinal canal×100%. Results All the patients were followed up,and the follow-up time was 12-24 months,mean 16.5 months. There was no significant difference in operation time,blood loss and complications between the 2 groups（P〈0.05）. There was also no significant difference in preoperative NDI,VAS score,opened laminae angle and sagittal diameter of C5 spinal canal between the 2 groups（P〈0.05）. At the final follow-up,the NDI,VAS score and sagittal diameter of C5 spinal canal were compared with those before operation in group A,and the differences were statistically significant（P〈0.05）;the spinal canal expansion rate was 51.1%;there was no statistical significance in opened laminae angle difference between immediately post-operation and final follow-up in group A（P〈0.05）. At the final follow-up,the NDI,VAS score and sagittal diameter of C5 spinal canal were compared with those before operation in group B,and the differences were statistically significant（P〈0.05）;the spinal canal expansion rate was 48.4%;there was statistical significance in opened laminae angle difference between immediate post-operation and final follow-up in group B（P〈0.05）. At the final follow-up,there was no significant difference between the 2 groups in NDI,VAS score and sagittal diameter of C5 spinal canal（P〈0.05）,but showed significant difference in opened laminae angle（P〈0.05）. Conclusion Both surgical protocols are effective in unilateral open-door cervical laminoplasty,moreover,the application of bionic nano-bone Y-plate in unilateral open-door cervical laminoplasty is reliable,simple and superior in preventing reclose of opened laminae angle. So the bionic nano-bone Y-plate could be a substitute for mini titanium plate.