单开门颈椎管扩大成形Neulen钛板内固定术后轴侧骨愈合观察

Clinical observation of bony union at hinge side after unilateral open-door laminoplasty plus Neulen plate instrumentation

中文关键词:  颈椎管狭窄症  单开门颈椎管扩大成形术  Neulen钛板  骨愈合  CT

英文关键词:Cervical canal stenosis  Expansion of unilateral open-door laminoplasty  Neulen plates  Bony fusion  CT

中文摘要:

  【摘要】 目的：观察和评价单开门颈椎管扩大成形Neulen钛板内固定术后颈椎管拱形结构的稳定性和轴侧骨愈合情况。方法：2012年1月~2012年9月采用单开门颈椎管扩大成形Neulen钛板内固定术治疗颈椎管狭窄症患者26例，男15例，女11例；年龄35~81岁，平均62岁。CT及MRI示多节段椎间盘突出、黄韧带增生肥厚16例，后纵韧带骨化10例。常规行颈后路单开门减压后用Neulen钛板和螺钉在开门部位支撑固定；16例患者使用5枚钛板固定，7例患者用4枚钛板固定，3例间隔使用3枚钛板固定。收集患者术后1周、3个月和6个月的轴位CT资料，根据门轴腹侧和背侧皮质部位连接骨质来评价骨愈合情况：腹侧和背侧部位均有骨质连接判定为骨愈合。结果：术中3个节段发生轴侧双层皮质断裂，置入钛板后未见椎板漂移和明显不稳，钛板固定后有效维持椎管扩大后椎板的位置，无神经损伤等并发症发生。术后3个月时26例患者Neulen钛板固定的117个节段中，80个节段轴侧骨愈合，愈合率为68.4%；术后6个月时随访到15例患者共69个节段（10例5枚钛板固定，4例4枚钛板固定，1例间隔使用3枚钛板固定），CT显示59个节段轴侧骨愈合，愈合率为85.5%。3个轴侧双层皮质断裂节段均未愈合，但椎管扩张状态仍能维持。随访期间无钛板移位和关门现象，无钛板固定的节段未发现关门现象。结论：Neulen钛板能够为开门后扩大的椎管提供稳定的即时和早期支撑，有利于轴侧早期骨愈合，有效维持椎管扩张状态，防止关门。

英文摘要:

  【Abstract】 Objectives: To observe the outcome and stability of bony union at hinge side after unilateral open-door laminoplasty plus Neulen plate instrumentation. Methods: From January 2012 to December 2012, 26 cases with cervical spinal canal stenosis underwent unilateral open-door expansive laminoplasty plus Neulen plate instrumentation. Of these patients, there were 15 males and 11 females, with a mean age of 62 years(range, 35 -81 years)． Preoperative CT and MRI showed multiple segmental disc herniation complicated with ligamentum flavum hypertrophy in 16 patients and ossification of posterior longitudinal ligament in 10 patients． Neulen plate complex was placed following routine unilateral open-door laminoplasty and decompression. 5 plates were placed in each of the 16 cases, 4 plates in each of the 7 cases, and interval use of 3 plates in each of the 3 cases. Postoperative CT scans at 1 week, 3 months and 6 months were collected. Each cortex (dorsal and ventral) was evaluated for the presence of bridging at cancellous or cortical bone. The overall bony healing of the hinge was determined by combining the status of dorsal and ventral cortices. Bony fusion was defined as bridging at the both ventral and dorsal cortices. Results: During operation, breakage of dorsal and ventral cortex occurred in three segments. But the lamina drift and instability were not noted after laminaplasty and instrumentation. No neurological deficit and other complications were noted either. CT scans at 117 segments of 26 patients at 3 months demonstrated bony fusion at 80 levels(68.4%). And of 69 segments of 15 patients at 6 months, 59 segments(85.5%) had bony fusion. During the follow-up, no instrument displacement was noted. Three segments presented with no bony fusion due to no bridging at ventral or dorsal cortices, but the expansion of the spinal canal was maintained afterwards. The segments without plate placement showed remarkable enlargement. Conclusions: Neulen plate can provide instant and early support of the expanded canals, promote early union at hinge, and maintain significant expansion of the spinal canal.