不同固定方法对颈椎单开门椎管扩大成形术铰链侧骨断端愈合的影响

Effects of two different fixations on hinge bony fusion in unilateral open-door cervical expansive laminoplasty

中文关键词:  椎管扩大成形术  颈椎  单开门  Centerpiece微型钢板  铰链侧  骨愈合

英文关键词:Unilateral open-door cervical expansive laminoplasty  Centerpiece mini-plate  hinge side  Bony fusion

中文摘要:

  【摘要】 目的：探讨不同固定方法对颈椎单开门椎管扩大成形术后铰链侧椎板骨断端骨愈合的影响。方法：纳入2009年9月~2011年3月行颈椎单开门椎管扩大成形Centerpiece微型钢板固定术且资料完整的58例患者，男47例，女11例，年龄35~81岁，平均61岁。5个节段开门56例，4个节段开门1例，3个节段开门1例。其中225个椎板采用Centerpiece微型钢板固定，62个椎板采用传统悬吊法固定。根据术后1周CT影像评估铰链侧椎板骨折情况，分为不完全骨折组、完全骨折骨断端无移位组和完全骨折骨断端移位组三个亚组；术后3个月及6个月行CT检查评估椎板铰链侧骨断端愈合情况，比较两种方法固定椎板的骨断端愈合情况。随访患者神经功能改善情况。结果：手术均顺利完成，124个椎板不完全骨折，118个椎板完全骨折断端无移位，45个椎板完全骨折断端有移位。术后随访6~27个月，平均16个月，随访期间未发现螺钉松动、钢板移位、椎板再关门及椎管再狭窄。椎管矢状径由术前9.9±2.4mm扩大到17.0±2.9mm，JOA评分由7.7±3.3分改善到12.5±3.4分，差异有统计学意义（P<0.001）。Centerpiece微型钢板固定椎板与悬吊法固定椎板术前及术后1周影像学指标无统计学差异，术后3个月骨断端愈合率差异有统计学意义（82% vs 70%，P=0.042），铰链侧骨折情况（P=0.728）及术后6个月骨断端愈合率（P=0.141）差异无统计学意义。完全骨折骨断端无移位节段椎板Centerpiece微型钢板固定较悬吊法固定椎板铰链侧术后3个月（86% vs 57%，P=0.004）及6个月（92% vs 85%，P=0.048）均有较高骨愈合率，差异有统计学意义；而不完全骨折组及完全骨折有移位组两种方法固定椎板铰链侧骨断端愈合率无统计学差异。结论：在颈椎单开门椎管扩大成形术中采用Centerpiece微型钢板固定能稳定椎板铰链侧骨折断端，有助于铰链侧发生完全骨折但无移位椎板的骨愈合。

英文摘要:

  【Abstract】 Objectives: To investigate the effects of two different fixations on the complete fracture and bony fusion of hinge side in unilateral open-door cervical expansive laminoplasty. Methods: 58 patients received the unilateral open-door cervical expansive laminoplasty from September 2009 to March 2011, including 47 males and 11 females, with a mean age of 61(35-81) years. 225 laminae were fixed by Centerpiece mini-plate and 62 laminae were fixed by suture suspension. 56 patients had five laminae opened, 1 patient had 4 laminae and 1 patient had 3 laminae opened. The Japan Orthopedic Association(JOA) score was used to evaluate the pre- and post- operative neurofunction. The fracture severity was evaluated by CT scans one week postoperatively, and all laminae were divided into three subgroups: incomplete fracture, complete fracture with no displacement and complete fracture with displacement. The bony fusion of hinge side was observed and compared between the two fixation methods under CT scans at three and six months postoperatively. Results: There were 124 incomplete fractured laminae, 118 complete fractured laminae with no displacement and 45 complete fractured laminae with displacement. The mean follow-up time was 6-27 months with an average of 16 months. No instrument displacement or broken, no lamina screw back-outs and no lamina re-closure were observed during follow-up. The cervical canal diameters were 9.9±2.4 preoperatively and 17.0±2.9 postoperatively, which showed significant difference. The JOA score showed significant improvement(P<0.001) from 7.7±3.3 preoperatively to 12.7±4.1 postoperatively. The Centerpiece mini-plate method had a higher hinge bony union rate than the other at 3 months after operation(82% vs. 70%, P=0.042), but no significant difference was noted as for the fracture severity(P=0.728) and bony fusion rate at 6months after operation(P=0.141) between two methods. Centerpiece mini-plate method for complete fracture with no displacement had significant higher hinge bony fusion, no matter 3 months(86% vs. 57%, P=0.004) or 6 months(92% vs. 85%, P=0.048) postoperatively. However the incidence for incomplete fracture and complete fracture with no displacement showed no significant. Conclusions: The Centerpiece mini-plate method for unilateral open-door cervical expansive laminoplasty increases the hinge′s stability and promotes the bony fusion of complete fracture with no displacement.