锚定钉在多节段脊髓型颈椎病单开门椎管扩大术中的应用

The application of anchoring nails in the expansive laminoplasty treating the multi-segments cervical spondylotic myelopathy

中文关键词:  脊髓型颈椎病  单开门椎管扩大术  多节段  锚定钉

英文关键词:Cervical spondylotic myelopathy  Expansive laminoplasty  Multi-segments  Anchoring nail

中文摘要:

  【摘要】 目的：探讨锚定钉在颈椎单开门椎管扩大术治疗多节段脊髓型颈椎病中的临床应用价值。方法：2009年1月~2011年1月，采用颈椎单开门椎管扩大术治疗多节段脊髓型颈椎病25例，男21例，女4例。年龄35～78岁，平均63.5岁。病程1.6~18年，平均3.6年。3节段18例，4节段7例。20例合并发育性或退变性颈椎管狭窄，均有颈脊髓受压症状，JOA评分3~11分，平均6.7±2.2分。均行颈椎单开门椎管扩大术，开门节段均为C3～C7，均采用锚定钉固定，固定节段为C3、C5、C7。结果：锚定钉均顺利置入，手术时间60~100min，平均75min。术中出血100~500ml，平均200ml，无脊髓损伤、脑脊液漏、硬膜外血肿等并发症发生。1例术后有颈肩部疼痛，给予对症处理2个月后疼痛消失。术后随访0.5~2.5年，平均1.9年，末次随访时JOA评分10~16分，平均13.8±1.4分，与术前比较差异有统计学意义（P<0.01），平均改善率为（68.1±7.5）%，优良率为88%。X线片检查显示颈椎曲度基本正常，椎管中矢状径与椎体中矢状径比值平均为1.2，锚钉无松动，无颈椎不稳及关门。结论：在颈椎单开门椎管扩大术治疗多节段脊髓型颈椎病时应用锚定钉固定开窗椎板方法简单可靠，可避免“关门”，临床疗效满意。

英文摘要:

  【Abstract】 Objective：To investigate the clinical application value of anchoring nails in expansive laminoplasty treating the multi-segments cervical spondylotic myelopathy.Method：From January 2009 to January 2011，25 patients with multi-segments cervical spondylotic myelopathy received operations of the cervical expansive laminoplasty.Among them，there were 21 male patients and 4 female patients.Their ages ranged from 35 to 78 years with a mean age of 63.5 years.The course of disease ranged from 1.6 to 18 years and a mean was 3.6 years.3 segments were involved in 18 patients，4 segments in 7 patients and 20 patients combined with developmental or degenerative cervical spinal stenosis.All patients had clinical symptom of cervical cord compression.The JOA scores were 3-11 points and a mean was 6.7±2.2 points before the operation.All of them received operations of cervical expansive laminoplasty，the segments were from C3 to C7，and C3，C5，C7 segments were anchorred with the anchoring nails.Result：During the operation，all nails were smoothly placed.The mean operative time was 75min and ranged from 60min to 100min.The mean volume of bleeding was 200ml and ranged from 100ml to 500ml.There was no complication such as spinal cord injury，cerebrospinal fluid leakage，hematoma outside of the scleromeninx and so forth.There was a patient having neck and shoulder pain after operation，and the pain disappeared with symptomatic treatment of 2 months.All patients were obtained follow-up for 0.5-2.5 years with an average of 1.9 years.The JOA scores were 10-16 points and a mean was 13.8±1.4 points at the last follow-up after operation.There were statistically significant differences compared with the results before operatin（P＜0.01）.The average improvement rate was （68.1±7.5）% and the rate of excellent and good results was 88%.Postoperative radiograph showed，the physiological curvature of cervical vertebra was basically normal，and average ratio of the middle sagittal diameter between the cervical vertebral canal and vertebral body was 1.2.The anchoring nails had no loosening.There was no case with cervical instability and door re-closure.Conclusion：The anchoring nail method is simple and reliable during the expansive laminoplasty treating the multi-segments cervical spondylotic myelopathy.It can avoid "door re-closure" and clinical efficacy is satisfactory.