单开门颈椎管扩大成形Centerpiece钛板内固定术治疗颈椎管狭窄症的早期临床疗效

Early clinical efficacy of unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation for cervical spinal stenosis

中文关键词:  颈椎管狭窄症  椎管扩大成形术  单开门  Centerpiece钛板  内固定  疗效

英文关键词:Cervical spinal stenosis  Expansive laminoplasty  Unilateral open-door  Centerpiece titanium plate  Internal fixation  Efficacy

中文摘要:

  【摘要】 目的：探讨单开门颈椎管扩大成形Centerpiece钛板内固定术治疗颈椎管狭窄症的早期临床疗效。方法：2009年8月~2010年6月采用后路C3~C7单开门椎管扩大成形Centerpiece钛板内固定术治疗颈椎管狭窄症患者30例，其中男性23例，女性7例，年龄42~81岁，平均65.2岁。MRI显示3个节段狭窄9例，4个节段狭窄15例，5个节段狭窄6例。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及MRI，在术前及术后3d、6个月的颈椎侧位X线片上测量C5节段椎管矢状径，计算椎管扩大率[（术后椎管矢状径-术前椎管矢状径）/（术前椎管矢状径）×100%]，评价椎管扩大和维持情况及门轴侧骨融合情况。结果：手术时间为145±20min，术中出血量为215±75ml，术中未出现相关并发症。1例术后第2天出现C5神经根症状，经2周保守治疗疼痛明显缓解，术后2个月时症状完全消失。随访9~20个月，平均14.6个月，术前JOA评分为8.7±0.8分，术后6个月为15.2±1.1分，改善率为（75±8）%。影像学复查示术后3d、6个月时颈椎管扩大满意，脊髓受压完全解除，C5节段椎管矢状径术前为9.2±0.8mm，术后3d、6个月均为15.9±1.2mm，椎管扩大率为（71.8±11.0）%。术后6个月时门轴侧均达骨性愈合，无1例出现关门及神经损害症状加重的情况。结论：单开门颈椎管扩大成形Centerpiece钛板内固定术是治疗颈椎管狭窄症的一种简便、安全的方法，早期疗效较满意。

英文摘要:

  【Abstract】 Objective：To evaluate the early clinical efficacy of unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation for cervical spinal stenosis.Method：From August 2009 to June 2010，30 cases suffering from cervical spinal stenosis underwent unilateral open-door expansive laminoplasty plus centerpiece fixation，of these，there were 23 males and 7 females，with a mean age of 65.2 years（range， 42-81 years）.Preoperative MRI showed stenosis at three levels in 9 cases，four levels in 15 and five levels in 6.The neurofunction was evaluated by Japan Orthopaedic Association（JOA） score；X-ray，CT and MRI were used to evaluate postoperative spinal canal enlargement and bone fusion at the hinge side.The sagittal diameter of C5 spinal canal on the lateral X-ray was measured before operation and 3 days，6 months after operation respectively，and the expansion rate of spinal canal was termed [as（postoperative sagittal diameter-preoperative sagittal diameter）/（preoperative sagittal diameter）×100%].Result：The average operation time was 145±20min；the average intraoperative blood loss was 215±75ml；no complications was noted during operation.C5 palsy was noted in 1 case 1 day after operation，which was relieved significantly after 2 weeks of correspondent intervention and resolved completely 2 months after operation.All patients were followed up for 9-20 months（mean 14.6 months）. The average JOA score for preoperation was 8.7±0.8 and 15.2±1.1 at 6 months after operation，with the improvement rate of （75±8）%.Radiographic findings showed spinal canal enlarged perfectly at 3 days and 6 months after operation.The mean sagittal diameter of C5 spinal canal was 9.2±0.8mm before operation and 15.9±1.2mm at 3 days and 6 months after operation，with the expansion rate of （71.8±11.0）%.CT scan showed bony fusion at hinge side at 6 months after operation without recurrence of cervical stenosis and neurofunction deterioration.Conclusion：Unilateral open-door expansive laminoplasty plus centerpiece titanium plate fixation is simple and reliable，and the early clinical efficacy is satisfactory.