钢缆式线锯及人工骨间隔物在颈椎管扩大成形术中的应用

Cervical posterior laminoplasty operation using T-saw and coralline hydroxyapatite spacer

目的 探讨使用钢缆式线锯 (T Saw线锯 )及人工骨CHA作间隔物行颈椎棘突纵割式椎管扩大成形术的优点及疗效。方法 对北京积水潭医院脊柱外科 31例多节段髓型颈椎病 ,5例颈椎后纵韧带骨化症 (OPLL) ,2例前路术后疗效差的患者采用特制线锯纵割棘突和HA人工骨替代髂骨作椎管后壁间隔物 ,行棘突纵割式椎管扩大成形术 ,采用JOA评分法对疗效进行评估。结果 对 38例患者术后随访 ,平均随访时间 2 6月。肢体麻木 ,肌力减退及行走不稳均有明显改善 ,术后扁平率改善 0 .2 3,人工骨间隔物愈合率 74 % ,无一例发生颈髓损伤。平均手术时间 2h 5 0min ;术中平均出血量2 80ml,平均JOA改善率 6 1%。结论 使用T Saw线锯及HA人工骨作间隔物行颈椎棘突纵割式椎管扩大成形术操作快捷安全 ,减压充分 ,术后改善率高 ,是颈椎管扩大成形术中的合理方法。

Objective To assess the efficacy of using T-saw and coralline hydroxyapatite(CHA) spacer in the cervical spinous process-splitting laminoplasty. Methods 38 patients were operated with cervical laminoplasty using T-saw and CHA spacer, among them there were 31 multisegmental cervical spondylotic myelopathy patients,5 ossification of posterior longitudinal ligament(OPLL) patients, 2 anterior fusion failure patients. All the patients were evaluated by JOA scores. Results we followed the 38 patients for average 26 months.Numbness,strength and gait were improved obviously. The flat rate of spinal cord in MRI improved 0.23;CHA fusion percentage 74%; no primary spinal cord injury was found.Average operation time was 2 hour 50 min;average bleeding during the operation was 280 ml; The average JOA score improve rate was 61%. Conclusion The methods, using T-saw and CHA spacer in the cervical spinous process-splitting laminoplasty,which was characterized by simple,short time on operation and thorough decompression of spinal cord, was a ideal optional method in the cervical laminoplasty operation.