改良Y型纳米骨板在多节段脊髓型颈椎病术中的应用效果

Application of modified Y-shaped nano-bone plate in multilevel cervical spondylotic myelopathy

目的探讨改良Y型纳米骨板在多节段脊髓型颈椎病(MCSM)术中的应用效果。方法回顾性分析2020年1月至2023年3月宝鸡市人民医院收治的103例MCSM患者资料,根据内固定材料不同进行分组,对照组51例,研究组52例。对照组男26例,女25例,年龄(54.43±4.12)岁,体重指数(23.28±1.49)kg/m^(2),病变节段:C_(2-7)5例、C_(3-6)7例、C_(3-7)30例、C_(4-7)9例,采用微型钛板内固定联合颈椎单侧肌肉韧带保留治疗;研究组男29例,女23例,年龄(53.01±4.58)岁,体重指数(23.04±1.36)kg/m^(2),病变节段:C_(2-7)6例、C_(3-6)8例、C_(3-7)33例、C_(4-7)5例,采用改良Y型纳米骨板固定联合颈椎单侧肌肉韧带保留治疗。两组患者术后均随访6个月。比较两组手术情况、疼痛情况、颈椎功能、颈椎影像学参数及并发症情况。采用t检验、χ^(2)检验。结果研究组手术时间短于对照组、术中出血量少于对照组[(104.21±15.29)min比(115.98±18.54)min、(131.68±21.01)ml比(145.21±24.16)ml],差异均有统计学意义(t=3.518、P=0.001,t=3.035、P=0.003)。术后3个月,研究组、对照组的视觉模拟评分法(VAS)评分比较[(1.41±0.22)分比(1.47±0.21)分],差异无统计学意义(P>0.05)。术后6个月,研究组的日本骨科协会(JOA)评分高于对照组[(21.98±2.03)分比(21.04±2.28)分],颈部功能障碍指数(NDI)低于对照组[(14.15±2.17)%比(15.26±2.43)%],颈椎前屈、后伸、左屈、右屈活动度均低于对照组[(40.17±3.24)°比(42.01±3.62)°、(39.24±3.43)°比(41.68±3.75)°、(34.84±2.31)°比(36.05±2.74)°、(35.26±2.51)°比(37.01±2.72)°],差异均有统计学意义(t=2.211、2.446、2.719、3.447、2.425、3.394,均P<0.05);两组颈椎侧位生理曲度比较[(10.34±1.43)°比(10.18±1.75)°],差异无统计学意义(t=0.509,P=0.612)。研究组并发症总发生率低于对照组[5.77%(3/52)比21.57%(11/51)],差异有统计学意义(χ^(2)=5.472,P=0.019)。结论与微型钛板内固定相比,改良Y型纳米骨板固定联合颈椎单侧肌肉韧带保留用于MCSM术中,可缩短手术时间,减少出血量,在改善患者颈椎功能方面更具优势,且安全性更高。

Objective To investigate the effect of modified Y-shaped nano-bone plate fixation in the operation of multilevel cervical spondylotic myelopathy(MCSM).Methods The data of 103 patients with MCSM admitted to Baoji People's Hospital from January 2020 to March 2023 were reviewed,including 51 patients(control group)who received micro-titanium plate fixation combined with unilateral cervical muscle ligament preservation,and 52 patients(study group)who received modified Y-shaped nano-bone plate fixation combined with unilateral cervical muscle ligament preservation,and were followed up for 6 months.In the control group,there were 26 males and 25 females,aged(54.43±4.12)years,with a body mass index of(23.28±1.49)kg/m^(2),and the diseased segments were C_(2-7)in 5 cases,C_(3-6)in 7 cases,C_(3-7)in 30 cases,and C_(4-7)in 9 cases.In the study group,there were 29 males and 23 females,aged(53.01±4.58)years,with a body mass index of(23.04±1.36)kg/m^(2),and the diseased segments were C_(2-7)in 6 cases,C_(3-6)in 8 cases,C_(3-7)in 33 cases,and C_(4-7)in 5 cases.The operation,pain,cervical function,cervical imaging parameters,and complications were compared between the two groups.t test andχ^(2)test were used.Results The operation time and intraoperative blood loss in the study group were lower than those in the control group[(104.21±15.29)min vs.(115.98±18.54)min,(131.68±21.01)ml vs.(145.21±24.16)ml],with statistically significant differences(t=3.518,P=0.001;t=3.035,P=0.003).There was no statistically significant difference in the Visual Analogue Scale(VAS)score between the study group and the control group 3 months after surgery[(1.41±0.22)points vs.(1.47±0.21)points](P>0.05).Six months after surgery,the Japanese Orthopaedic Association(JOA)score of the study group was higher than that of the control group[(21.98±2.03)points vs.(21.04±2.28)points],the Neck Dysfunction Index(NDI)was lower than that of the control group[(14.15±2.17)%vs.(15.26±2.43)%],and the ranges of motion of anterior flexion,posterior extension,left flexion,and right flexion were lower than those of the control group[(40.17±3.24)°vs.(42.01±3.62)°,(39.24±3.43)°vs.(41.68±3.75)°,(34.84±2.31)°vs.(36.05±2.74)°,(35.26±2.51)°vs.(37.01±2.72)°],with statistically significant differences(t=2.211,2.446,2.719,3.447,2.425,and 3.394,all P<0.05).There was no statistically significant difference in the physiological curvature of the cervical lateral position between the two groups 6 months after surgery[(10.34±1.43)°vs.(10.18±1.75)°](t=0.509,P=0.612).The total complication rate of the study group was lower than that of the control group[5.77%(3/52)vs.21.57%(11/51)],with a statistically significant difference(χ^(2)=5.472,P=0.019).Conclusion Compared with micro-titanium plate internal fixation,modified Y-shaped nano-bone plate fixation combined with unilateral cervical muscle ligament retention for MCSM surgery can reduce the operation time and blood loss,and has more advantages and safety in improving the function of patients'cervical vertebrae.