Arch钢板在颈椎管单开门扩大成形术中的早期应用

Early clinical application of unilateral open-door cervical expansive laminoplasty with Arch steel plate fixation for cervical spinal stenosis

目的探讨Arch钢板在颈椎管单开门扩大成形术中的早期应用结果。方法回顾性分析2010年4月~2012年6月在后路单开门椎管扩大成形术中应用Arch钢板的患者25例。记录所有患者手术前后JOA评分(17分法)、术前及术后7天、6个月C5节段椎管矢状径,手术前后进行对比。以JOA评分(17分法)及其改善率评价术后神经功能改善情况;术后复查颈椎X线、CT,在术后7天、6个月颈椎侧位X线片上测量C5节段椎管矢状径,计算椎管扩大率,评价椎管扩大和维持情况及门轴侧骨融合情况;记录所有术中及术后并发症。结果随访时间均超过6个月,3例病人分别出现了轴性症状、C5神经麻痹及脑脊液漏等并发症,经保守治疗后好转;术后均无再关门及神经损害加重现象。所有患者术后临床症状缓解,术后JOA评分与术前比较,差异均有统计学意义(P<0.05),术后JOA改善率为(57.05±16.97)%,优良率为72%。影像学复查示术后7天、6个月时颈椎管扩大满意,门轴侧骨性愈合,术后7天、6个月C5节段椎管矢状径与术前比较,差异均有统计学意义(P<0.05),术后7天和术后6个月之间比较,差异无统计学意义(P>0.05),术后椎管扩大率为(97.74±9.06)%。结论在单开门颈椎管扩大成形术中,Arch钢板的应用是治疗颈椎管狭窄症的一种简便、可靠、安全的方法,早期临床疗效较满意。

Objective To evaluate the early uses of unilateral open-door cervical expansive laminoplasty with Arch titanium plate fixation for cervical spinal stenosis.Methods From April 2010 to June 2012,25 cases suffering from cervical spinal stenosis underwent unilateral open-door expansive laminoplasty with Arch titanium fixation.We recorded the Japan Orthopaedic Association(JOA) score at preoperatrive and postoperative.The sagittal diameter of C5spinal canal before operation and 7 days,6 months after operation respectively also were recorded.The neurofunction was evaluated by JOA score and its improvement rate; X-ray,CT and MRI were used to evaluate postoperative spinal canal enlargement and bone fusion at the hinge side.The sagittal diameter of C5spinal canal on the lateral X-ray was measured before operation and 7 days,6 months after operation respectively,and the expansion rate of spinal canal was calculated.All the intraoperative and postoperative complications of every patient were also recorded.Results The follow up period of every patient was not less than 6 months.Axial symptoms、C5palsy and cerebrospinal fluid leakage were noted in 3 cases after operation,which were relieved significantly after correspondent intervention.There is no recurrence of cervical stenosis and neurofunction deterioration after operative.Every patient got symptomatic relief.There were significant differences between preoperative and postoperative with regard to JOA score(P<0.05).The average JOA score improvement rate is(57.05±16.97) % after operation,with the efficiency rate of 72%.Radiographic findings showed spinal canal enlarged perfectly and bony fusion at hinge side at 7 days and 6 months after operation.Compareed the C5segment sagittal diameter 7 days or 6 months after operation with preoperative,the differences were statistically significan(P<0.05).There were no significant differences with regard to sagittal diameter between the postoperative two groups(P>0.05).The expansion rate of spinal canal after operation is(97.74±9.06) %.Conclusion Among unilateral open-door expansive laminoplasty,the application of Arch titanium plate is a simple、reliable and safe method to cure cervical spinal stenosis,and the early clinical efficacy is satisfactory.