颈椎后路单开门联合椎弓根螺钉固定治疗颈椎管狭窄症伴不稳

Posterior Cervical Open-door Laminoplasty Combined with Pedicle Screw Fixation for Cervical Spinal Stenosis with Instability

目的探讨颈椎后路单开门联合椎弓根螺钉固定治疗颈椎管狭窄症伴不稳的必要性及疗效。方法本文选取31例颈椎管狭窄症伴不稳的患者,其中男25例,女6例;年龄39~70岁,平均55岁。记录手术时间、术中出血量及并发症情况;采用日本骨科协会(Japanese orthopaedic association,JOA)评分评估神经功能;拍摄X线片观察颈椎生理曲度;采用CT三维重建评估椎弓根螺钉位置。结果所有患者均顺利完成手术,手术时间110~180 min,平均手术时间132min;出血量250~450mL,平均出血量320mL;所有患者均获随访,随访时间12~28个月,平均15个月。末次随访时JOA评分由术前(11.16±2.07)分提高至(15.19±0.75)分,差异具有统计学意义(t=-15.03,P<0.01);颈椎曲度由术前(6.52±7.34)°提高到末次随访时的(9.00±11.01)°,差异具有统计学意义(t=2.79,P<0.01)。本组患者共置入螺钉136枚,其中螺钉穿出率为10.3%,均为外壁穿破。本组患者术后3例出现脑脊液漏,1例患者出现C5神经根麻痹,所有患者无一例发生切口感染、神经损伤或门轴断裂。结论对于颈椎管狭窄症伴不稳的患者,一期颈椎后路单开门联合椎弓根螺钉固定术是一种安全有效的方法。

Objective To investigate the the necessity and curative effect of posterior cervical open-door laminoplasty combined with pedicle screw fixation for cervical spinal stenosis with instability.Methods 31 cases of cervical stenosis with unstable patients were selected to record the operation time,intraoperative bleeding and complications.Using JOA score of Japanese Orthopaedic Association（JOA）to assess neurological function;The physiological curvature of cervical vertebra was observed by X-ray.The position of vertebral pedicle screw was assessed by CT 3 dreconstruction.Results All the patients completed the operation successfully,with an average operation time of 132 min（110~180 min）and 320 mL（250~450 mL）of average blood loss.All patients were followed up for 12 months to 28 months with an average of 15 months.At the end of the follow-up,the JOA score was improved to（15.19±0.75）from（11.16±2.07）points before surgery,and the difference was statistically significant（t=-15.03,P〈0.01）.The curvature of the cervical vertebra was increased from the preoperative（6.52±7.34）degree to the last follow-up（9.00±11.01）degree,and the difference was statistically significant（t=2.79,P〈0.01）.In this group,the total number of screws was 136,of which the screw perforation rate was 10.3%,all of which perforated the outer wall.There were 3 cases of cerebrospinal fluid leakage and 1 patient with C5 nerve root paralysis.None of the patients underwent incision infection,nerve injury or the rupture of the portal axis.Conclusion One-stage posterior cervical open-door combined with pedicle screw fixation is a safe and effective method for patients with cervical spinal stenosis and instability.