钛板固定在颈椎后路单开门椎管扩大椎板成形术中的应用效果

Application effect of titanium plate fixation in posterior cervical expansive open-door laminoplasty

目的探讨钛板固定在颈椎后路单开门椎管扩大椎板成形术中的应用效果。方法回顾性分析2015-04-2021-07郑州大学第二附属医院骨科一病区行颈椎后路单开门椎管扩大椎板成形术的66例脊髓型颈椎病患者的临床资料,根据椎板开门固定方式分为钛板组(35例)和丝线组(31例)。比较2组患者的基线资料和手术时间、术中出血量,以及手术前后的日本骨科协会(JOA)评分。记录手术前后C 3~7各节段椎管的矢状径、椎板开门角度。统计术后再关门、轴性症状并发症发生率。结果2组患者的基线资料,以及手术时间、术中出血量差异无统计学意义(P>0.05)。2组患者术后3个月及术后1年时的JOA评分均较术前明显改善,差异均有统计学意义(P<0.05),但2组间的差异无统计学意义(P>0.05)。2组患者术后3个月及术后1年时的C 3~7各节段椎管矢状径均较术前明显改善,其中钛板组的改善效果优于丝线组,差异均有统计学意义(P<0.05);术后3个月及术后1 a钛板组椎板开门角度均大于丝线组,差异均有统计学意义(P<0.05)。术后钛板组轴性症状发生率低于丝线组,差异具有统计学意义(P<0.05)。丝线组发生再关门3例,钛板组未出现再关门病例。结论钛板固定和丝线悬吊固定均能够扩大椎管、改善脊髓功能;但钛板在维持术后椎板开门角度、椎管矢状径大小、改善轴性症状、减少再关门的发生率方面更具优势。

Objective To investigate the application effect of titanium plate fixation in posterior cervical expansive open-door laminoplasty.Methods The clinical data of 66 patients with cervical spondylotic myelopathy who underwent posterior cervical expansive open-door laminoplasty in the First Ward of Orthopedics Department of the Second Affiliated Hospital of Zhengzhou University from April 2015 to July 2021 were retrospectively analyzed.According to the opening fixation method of the lamina,the patients were divided into titanium plate group(35 cases)and silk suture group(31 cases).The baseline data,operation time,intraoperative blood loss,and preoperative and postoperative Japanese Orthopaedic Association(JOA)score were compared between the two groups.The sagittal diameter of C 3-7 spinal canal and the opening Angle of lamina were recorded before and after operation.The incidence of postoperative re-closure and axial symptom complications was counted.Results There were no significant differences in baseline data,operation time,and intraoperative blood loss between the two groups(P>0.05).The JOA scores of the two groups at 3 months and 1 year after operation were significantly improved when compared with those before operation(P<0.05),but there was no significant difference between the two groups(P>0.05).The sagittal diameters of C3-7 segments of the two groups at 3 months and 1 year after operation were significantly improved when compared with those before operation,and the improvement effect of the titanium plate group was better than that of the silk suture group,and the differences were significant(P<0.05).The opening angles of lamina in titanium plate group were significantly larger than those of silk suture group at 3 months and 1 year after operation(P<0.05).The incidence of axial symptoms in the titanium plate group was lower than that of the silk suture group,and the difference was statistically significant(P<0.05).There were 3 cases of re-closure in the silk suture group and no case of re-closure in the titanium plate group.Conclusion Both titanium plate fixation and silk suspension fixation can enlarge the spinal canal and improve the function of spinal cord.However,titanium plate has more advantages in maintaining the opening Angle of the lamina,the sagittal diameter of the spinal canal,improving the axial symptoms and reducing the incidence of re-closing.