3节段与5节段微型钛板固定行后路单开门颈椎管扩大成形术的手术情况及疗效比较

Comparison of surgical results and outcomes of posterior single-door cervical laminoplasty with 3-segment and 5-segment mini-titanium plate fixation

目的在多节段脊髓型颈椎病(Cervical spondylotic myelopathy,CSM)行颈后路单开门椎管扩大成形术治疗中,比较3节段与5节段微型钛板固定的手术情况及疗效。方法回顾性分析自2015年7月-2018年3月采用该术式治疗的CSM患者73例,按微型钛板固定方式分成两组:A组43例,仅对C3、C5、C7节段行微型钛板固定;B组30例,术中对C3-C7节段均行钛板固定。对比两组患者的手术情况、医疗费用和临床疗效。结果与B组相比,A组患者的手术时间显著缩短,术中出血量亦显著减少,手术费用显著降低,差异均有统计学意义(P<0.05)。A、B两组患者术后1个月和1年的JOA评分均显著升高(P<0.05),但术后的JOA改善率组间差异均无统计学意义(P>0.05)。B组术后3个月和1年的颈椎曲度显著小于A组(P<0.05),组间颈椎活动度的变化差异无统计学意义(P>0.05)。两组术后3个月内的轴性症状分级和总发生率差异均无统计学意义(P>0.05)。结论微型钛板联合颈后路单开门椎管扩大成形术治疗多节段CSM可取得良好疗效;3节段“跳跃式”固定有助于缩短手术时间、减少出血量,并显著降低手术费用,具有明显优势。

Objective To compare the clinical results of posterior single-door laminoplasty for cervical spondylotic myelopathy(CSM)with 3-segment and 5-segment mini-titanium plate fixation.Methods A retrospective analysis was made in 73 CSM patients treated by this method from July 2015 to March 2018.The patients were divided into two groups according to the mini-titanium plate fixation method:group A(43 cases)with only mini-titanium plate fixation for C3,C5 and C7 segments;group B(30 cases)with C3-C7 segments fixed by mini-titanium plate during operation.The operation conditions,medical expenses and clinical effects of the two groups were compared.Results Compared with group B,the operation time of group A was significantly shortened,the amount of intraoperative bleeding was significantly reduced,the operation cost was significantly reduced,the differences were statistically significant(P<0.05).The JOA scores of group A and group B increased significantly at 1 month and 1 year after operation(P<0.05),but there was no significant difference in the improvement rate of JOA between the two groups(P>0.05).The cervical curvature of group B at 3 months and 1 year after operation was significantly lower than that of group A(P<0.05),and there was no significant difference in cervical motion between the two groups(P>0.05).There were no significant differences in the classification of axial symptoms and the total incidence rate between the two groups within 3 months after operation(P>0.05).Conclusion Mini-titanium plate combined with posterior cervical single-door laminoplasty can achieve good results in the treatment of multi-level CSM;3-level"jump"fixation can shorten the operation time,reduce the amount of bleeding,and significantly reduce the cost of surgery,which has obvious advantages.