颈后路单开门椎管扩大成形联合侧块螺钉内固定术治疗伴不稳的多节段脊髓型颈椎病

Efficacy of Posterior Cervical Single-Door Laminoplasty Combined with Lateral Mass Screw Internal Fixation on the Treatment of Multi-Segment Cervical Spondylotic Myelopathy with Instability

目的:探讨颈后路微钛板单开门椎管扩大成形联合侧块螺钉内固定术治疗伴不稳的多节段脊髓型颈椎病(Multilevel Cervical Spondylotic Myelopathy, MCSM)的临床疗效。方法:回顾性分析2018年3月至2020年5月颈后路微钛板单开门椎管扩大成形联合侧块螺钉内固定术治疗31例伴不稳的多节段脊髓型颈椎病患者临床资料。记录手术时间、术中出血量、术后引流量和并发症,比较手术前后CCobb角、颈椎活动度(Range of Motion, ROM)、椎管矢状径和椎管横截面积,并计算椎管扩大率。采用日本骨科协会(Japanese Orthopaedic Association, JOA)评分评估术后神经功能改善情况,采用疼痛视觉模拟量表(Visual Analogue Scale, VAS)评分和颈椎功能障碍指数(Neck Disability Index, NDI)评价患者疼痛和功能改善情况。结果:31例患者均顺利完成手术并获随访,手术时间为(178.25±10.08) min,术中出血量为(208.06±40.69) mL,术后引流量为(188.45±111.78) mL。术后CCobb角、椎管矢状径、椎管横截面积、JOA评分、VAS评分和NDI较术前有明显改善,差异均有统计学意义(P<0.05);术后1年椎管扩大率为77.10%±10.56%,术后1年JOA评分改善率为81.39%±9.78%。术后颈椎ROM与术前比较明显降低,差异有统计学意义(P<0.05)。术后发生颈部轴性症状5例,C神经根麻痹1例。所有患者未发生螺钉松动、脱落和扩大的椎管再关门现象。术后影像学检查显示门轴侧和侧块固定节段骨融合良好。结论:颈后路微钛板单开门椎管扩大成形联合侧块螺钉内固定术对伴不稳的多节段脊髓型颈椎病患者颈椎管的减压、脊髓功能的改善和颈椎的稳定重建具有显著疗效。

Objective:To investigate the clinical efficacy of posterior cervical micro-titanium plate single-door laminoplasty combined with lateral mass screw internal fixation on the treatment of multilevel cervical spondylotic myelopathy(MCSM) with instability.Methods:The clinical data of 31 patients with unstable MCSM treated by posterior cervical micro-titanium plate single-door laminoplasty combined with lateral mass screw internal fixation from March 2018 to May 2020 were retrospectively analyzed.The operation time, intraoperative blood loss, postoperative drainage and complications were recorded, and the CCobb angle, range of motion(ROM),sagittal diameter of spinal canal and CCobb angles on imaging images before and after operation were compared.The cross-sectional area of the spinal canal was calculated, and the expansion rate of the spinal canal was calculated.The Japanese orthopaedic association(JOA) scores were used to evaluate postoperative neurological improvement, and the pain visual analogue scale(VAS) scores and neck disability index(NDI) were used to evaluate the pain and functional improvement.Results:All 31 patients successfully completed the operation and were followed up.The operation time was(178.25±10.08) min, the intraoperative blood loss was(208.06±40.69) mL,and the postoperative drainage volume was(188.45±111.78) mL.The CCobb angle, sagittal diameter of spinal canal, cross-sectional area of spinal canal, JOA scores, VAS scores and NDI after operation were significantly improved compared with those before operation, and the differences were statistically significant(P<0.05);1 year after operation, the rate of spinal canal enlargement was 77.10%±10.56%,and the improvement rate of JOA scores was 81.39%±9.78%.The cervical spine ROM after operation was significantly lower than that before operation, and the difference was statistically significant(P<0.05).There were 5 cases of cervical axial symptoms and 1 case of Cnerve root palsy after operation.All patients did not experience screw loosening, dislodging and reclosing of the spinal canal.Postoperative imaging data showed good fusion of the portal axis and lateral mass fixation segments.Conclusion:Posterior cervical micro-titanium plate single-door laminoplasty combined with lateral mass screw internal fixation has a significant efficacy on the decompression of the cervical spinal canal, improvement of spinal cord function and stabilization of the cervical spine in patients with unstable MCSM.