普通螺钉在多节段颈椎管狭窄症单开门椎管扩大术中的应用

Common screws in unilateral open-door cervical expansive laminoplasty for multi-level cervical spinal stenosis

目的探讨普通钛质皮质骨螺钉在多节段颈椎管狭窄症颈后路单开门椎管扩大术中的应用及近中期临床疗效。方法对2012年3月至2018年5月宁德市医院收治的25例多节段颈椎管狭窄症患者行颈后路单开门椎管扩大成形普通钛质皮质骨螺钉内固定术。记录手术时间、术中出血量、术后引流量、住院时间、日本骨科协会(JOA)评分、颈椎管矢状径、颈椎管横截面积、颈椎活动度(ROM)、颈椎曲率指数(CCI)及手术并发症情况。结果本组均获得随访,随访时间18~70(54.72±7.16)个月。末次随访时JOA评分[(13.67±1.14)分vs(7.83±1.86)分]、颈椎管矢状径[(17.80±1.11)mm vs(11.10±1.06)mm]、颈椎管横截面积[(259.93±23.50)mm^(2) vs(130.63±2.63)mm^(2)]均较术前改善(P<0.01)。末次随访时颈椎管ROM(41.00°±3.79°vs 41.33°±3.87°)、颈椎管CCI[(11.25±0.64)mm vs(11.26±0.64)mm]均较术前稍下降,差异无统计学意义(P>0.05)。结论颈后路单开门椎管扩大成形普通钛质皮质骨螺钉内固定治疗多节段颈椎管狭窄症近中期疗效满意,操作简单、价格低廉、固定牢靠、损伤小、安全可行。

Objective To investigate the application of common titanium cortical bone screw in unilateral open-door laminoplasty through posterior approach for multi-level cervical spinal stenosis and the short-to mid-term clinical efficacy.Methods From March 2012 to May 2018,in Ningde Municipal Hospital 25 patients with multiple segmental cervical spinal stenosis received single open-door laminoplasty through posterior approach with titanium cortical bone screws internal fixation.The operation time,intraoperative blood loss,postoperative drainage volume,hospital stay,Japanese Orthopedic Association(JOA)score,sagittal diameter of cervical spinal canal,cross-sectional area of cervical spinal canal,cervical range of motion(ROM),cervical curvature index(CCI)and surgical complications were observed and recorded.Results The patients were followed up for 18-70(54.72±7.16)months.Compared with those before operation,JOA score[(13.67±1.14)points vs(7.83±1.86)points],sagittal diameter of cervical canal[(17.80±1.11)mm vs(11.10±1.06)mm]and cross-sectional area of cervical canal[(259.93±23.50)mm^(2) vs(130.63±2.63)mm^(2)]were significantly improved at the last follow-up(P<0.01).There were no statistical differences in cervical ROM(41.00°±3.79°vs 41.33°±3.87°)and CCI[(11.25±0.64)mm vs(11.26±0.64)mm],even though they were slightly lower at the last follow-up(P>0.05).Conclusion In the treatment of multi-level cervical spinal stenosis,posterior single door laminoplasty with titanium cortical bone screws internal fixation has a satisfactory near-and medium-term effect,with easy operating,inexpensive,firm fixation,small injury,safety and feasibility.