颈椎后路ARCH椎板成形系统联合选择性侧块螺钉固定术治疗伴短节段不稳的多节段颈椎病

ARCH laminoplasty system in combination with selective lateral mass screw fixation for multisegmental cervical spondylosis with short-segmental instability

探讨ARCH椎板成形系统联合选择性侧块螺钉固定术治疗伴短节段不稳的多节段颈椎病的临床疗效。方法2012年2月一2014年11月，本院采用ARCH椎板成形系统联合选择性侧块螺钉固定术治疗25例伴短节段不稳的多节段颈椎病患者，其中男16例，女9例；年龄36^65岁；单节段不稳22例，双节段不稳3例；均伴有颈肩部疼痛、僵硬感等颈椎不稳症状。术前、术后摄颈椎正侧位、过伸位、过屈位X线片，测量颈椎曲度、颈椎活动度（RQM)、Pavlov比值（椎管矢状径与椎体矢状径之比），并对术前、术后结果进行比较。用日本骨科学会（J0A)评分对手术效果进行评价。结果所有手术顺利完成，术后随访12^24个月，平均17.5个月。本组患者JOA评分由术前平均6.2分提高到末次随访时的平均13.6分，平均改善率68.5%。术后Pavlov比值>0.83。术后颈椎ROM及曲度较术前略有改善，但差异无统计学意义CP>0.05)。所有患者颈椎不稳节段均固定牢靠。术后24例患者颈椎不稳症状缓解，其中1例出现典型轴性痛表现；1例出现C;神经根麻痹症状，3个月后逐渐恢复。结论颈椎后路ARCH椎板成形系统联合侧块螺钉固定术，结合两种术式的优点，在实现减压、稳定、适当保留部分ROM的同时，可减少术后并发症的产生，是一种可供选择的较好的手术方式。

Objective To explore the clinical efficacy of ARCH laminoplasty system combined with selective lateral mass screwfixation for multisegmental cervical spondylosis with short-segmental instability of the cervical vertebra. Methods From February 2012 to November 2014,using cervical posterior ARCH laminoplasty system miniature titanium plate fixation combined with selective lateral mass screwfixationin 25 patients with multisegmental cervical spondylosis with short-segmental instability of the cervical vertebra who were composed of 16 malesand 9 females,aged 36- 65 years;single segmental instability in 22 and double segmental instability in 3 patients. All the patient had cervical vertebra instability symptoms such as neckshoulder pain,stiffness. Cervical roentgenographs of anteroposterior,lateral,hyperextension and hyperflexion position were taken at pre-operation and post-operation,then the cervical curve,range of motion(ROM) and Pavlov ratio(Spinal canal to vertebral body ratio) were measured. The preoperative and postoperative results were compared. The Japanese Orthopaedic Association(JOA) score were used to evaluate the outcome of surgery. Results All operations were completed successfully. These patients were followed up for 12- 24 months,mean 17.5 months. The JOA score increased from 6.2 pre-operatively to 13.6 at the end of the follow-up,with a mean improvement rate of 68.5%. The Pavlov ratio was > 0.83 at post-operation. The postoperative ROM and cervical curve were slightly improved compared to the preoperation,but the difference was not statistically significant(P > 0.05). All the unstable segments were fixed reliably. After operation,instability symptoms were relieved in 24 patients,only 1 patient had typical axial pain. C_5 nerve root paralysis appeared in 1 case,and recovered gradually after 3 months. Conclusion Combination of ARCH laminoplasty system and lateral mass screw fixation possesses advantages of the 2 kinds of operation and is a good operation method reducing the generation of postoperative complications while performing cervical decompression,maintaining the stability and keeping partial ROM of the cervical vertebra.