颈椎单开门椎管成形间隔迷你钢板固定术治疗多节段颈椎病临床疗效

Clinical outcomes of cervical single open-door laminoplasty with mini-plate fixation for multi-segment cervical spondylosis

目的:探讨颈后路单开门椎管扩大成形术采用间隔迷你钢板固定治疗多节段颈椎病的疗效。方法:收集2013年7月~2015年9月采用单开门椎板成形加间隔(C3、C5)迷你钢板固定术治疗的30例多节段颈椎病患者,男22例,女8例,年龄46~76岁,平均(59.5±10.7)岁。记录平均手术时间、出血量以及术后有无颈部轴线痛和颈5神经根麻痹发生,采用日本骨科协会(JOA)颈椎评分评估手术前后及末次随访时神经功能,通过手术前后及末次随访时X线侧位片测量椎管直径变化及有无内固定松动和断裂。结果:本组平均手术时间为(151.9±39.1)min,平均出血量(275.7±60.6)mL,无颈椎轴线痛及C5神经根麻痹发生。所有病例均获得随访,平均随访时间为(49.2±5.6)个月(36~65个月)。随访过程中无内固定松动及断裂并发症。患者末次随访JOA评分(15.3±1.26)均高于术后和术前(14.3±1.53和8.43±1.25,P<0.05),患者术后JOA评分高于术前(P<0.05)。患者术前有固定节段和无固定节段椎管平均直径均低于术后和末次随访(P<0.05),而患者术后和末次随访有固定节段和无固定节段椎管平均直径差异无统计学意义(P>0.05)。结论:多节段颈椎病采用单开门椎管扩大成形加间隔迷你钢板固定术治疗是安全、有效和经济的手术方法。

Objective:To assess the clinical efficacy of cervical posterior single open-door laminoplasty with alternative levels centerpiece plate fixation for multi-segment cervical spondylosis.Methods:Thirty patients(22 males and 8 females) with multi-segment cervical spondylosis undergone posterior single-door laminoplasty with alternative levels centerpiece mini-plate fixation were included from July 2013 to September 2015.The patients aged from 46 to 76 years,with an average of(59.5±10.7) years.Clinical indexes were maintained on the operative time,volume of blood loss,incidences of cervical axial pain and nerve root paralysis at C5.Japanese Orthopedic Association(JOA) scoring was used to evaluate the neural function before and after operation and at the final follow-up.Lateral radiography was performed to observe the changes of spinal canal diameter before and after surgery and at the final follow-up as well as incidences of loosened or broken plate.Results:The average operative time and blood loss was(151.9±39.1) min and(275.7±60.6) mL,respectively for the patients included.No cervical axial pain and nerve palsy at C5 occurred.All patients were followed for 36 to 65 months(mean 49.2 months),and the follow-up showed no occurrence of loosened or broken plate.JOA scoring was 15.3± 1.26 at the final follow-up,which was higher than the scoring after surgery(14.3±1.53) and before operation(8.43±1.25)(P<0.05),and the scoring was also higher after operation than before laminoplasty(P<0.05).Mean spinal canal diameter before surgery was smaller at the fixed or non-fixed segment as compared with the diameter following laminoplasty and at the final follow-up(P<0.05),yet the average spinal canal diameter was not different at the fixed or non-fixed segment after operation and at the final follow-up(P>0.05).Conclusion:Single open-door laminoplasty with alternative levels centerpiece plate fixation can be safe,effective and economical surgical method for patients with multi-segment cervical spondylosis.