颈后路单开门结合Vertex钉棒系统和Centerpiece 钉板系统内固定治疗多节段脊髓型颈椎病

Comparison of Vertex rod-screw system and Centerpiece plate-screw system in cervical expansive open-door laminoplasty for multilevel cervical spondylotic myelopathy

中文关键词:  脊髓型颈椎病  单开门椎板成形术  钉棒系统  钉板系统

英文关键词:Cervical spondylotic myelopathy  Expansive open-door laminoplasty  Rod-screw system  Plate-screw system

中文摘要:

  【摘要】 目的：评价颈后路单开门结合Vertex钉棒系统和Centerpiece钉板系统内固定治疗多节段脊髓型颈椎病的临床疗效。方法：2008年5月~2012年8月对我院因多节段脊髓型颈椎病需行手术治疗的36例患者，入院后随机采用下颈椎侧块螺钉结合棘突椎板螺钉Vertex钉棒系统组合固定椎板成形术或Centerpiece钉板系统椎板成形术，其中16例患者开门侧采用下颈椎侧块螺钉结合棘突椎板螺钉Vertex钉棒系统组合固定（A组），20例患者采用Centerpiece钉板系统固定（B组）。记录手术时间、术中出血量、手术前后神经功能JOA分值及颈痛VAS分值，观察术后是否出现C5神经根麻痹。在X线侧位片上测量C2与C7椎体后缘切线夹角（α），以中立侧位X线片的α为颈椎曲度，以过伸过屈位α的差异计算颈椎活动度，颈椎CT片上测量椎板掀开的角度（β）。两组术前一般资料比较均无统计学差异（P>0.05）。结果：两组手术时间和术中出血量比较均无统计学差异（P>0.05）。所有患者切口愈合良好，术中无神经、血管损伤，术后无伤口感染、脑脊液漏发生，A、B组术后各有1例出现严重轴性症状，B组2例术后出现C5神经根麻痹，经治疗后均缓解，A组无C5神经根麻痹出现。A组随访11～23个月，平均18.5±2.7个月；B组随访10～22个月，平均17.9±3.2个月，两组比较无统计学差异（P>0.05）。A组末次随访时JOA分值平均改善率为（55.78±1.23）%，B组为（54.25±1.48）%，两组比较无统计学差异（P>0.05）。A组术后2周颈痛VAS分值增加1.10±0.31，与B组（1.20±0.27）比较无统计学差异（P>0.05）；末次随访时A组VAS分值为2.13±0.16，与术前（3.23±1.28）比较有统计学差异（P<0.05）；末次随访时B组VAS分值为2.07±0.21，与术前（3.35±1.15）比较有统计学差异（P<0.05）。末次随访时A、B组颈椎曲度分别为16.3°±5.7°和15.6°±6.6°，与术前（16.5°±4.1°和15.8°±5.2°）比较均无统计学差异（P>0.05）。A组末次随访时椎板开门角度为45.6°±3.6°，与B组（48.4°±5.4°）比较有统计学差异（P<0.05）。末次随访时，A组平均颈椎活动度减少5.78°±4.35°，与B组减少5.91°±3.16°比较无统计学差异（P>0.05）。结论：采用Vertex钉棒系统和Centerpiece钉板系统实施单开门椎板成形术治疗多节段脊髓型颈椎病均能取得较好的临床疗效。但采用Vertex钉棒系统实施单开门椎板成形术可能在减少术后C5神经根麻痹发生率上有一定价值。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical outcomes of Vertex rod-screw system and Centerpiece plate-screw system in cervical expansive open-door laminoplasty for multilevel cervical spondylotic myelopathy.Methods: From May 2008 to August 2012, 36 patients with multilevel cervical spondylotic myelopathy were treated with open-door laminoplasty by lower cervical spinous process laminar screw combined with either lateral mass screw Vertex rod-screw system or Centerpiece plate-screw system randomly. 16 patients undergoing expansive open-door laminoplasty by lower cervical spinous process laminar screw combined with lateral mass screw Vertex rod-screw system were included as group A, while 20 patients undergoing expansive open-door laminoplasty by Centerpiece plate-screw system as group B. The operation time, blood loss, preoperative and postoperative JOA scores, neck and shoulder VAS scores and postoperative C5 nerve palsy were recorded. The cervical curvature angle(α) was defined as the cross angle between posterior vertebral body margins of C2 and C7 on cervical radiographs. The cervical range of motion according to the difference of the angle of α between hyperextension and hyperflexion was calculated. The angle of the opened laminae(β) was measured on CT scan at final follow-up. There were no significant differences with regard to preoperative demographic data between two groups(P>0.05). Results: There were no significant differences with regard to operation time and blood loss between two groups(P>0.05). Skin incisions healed well in all patients. There was no neurovascular injury when placing the implants, and no postoperative wound infection, cerebrospinal fluid leakage or other complication was noted. Follow-up time ranged 11-23 months(average 18.5±2.7 months) in group A and 10-22 months(average 17.9±3.2 months) in group B, there was no significant difference between two groups in follow-up time(P>0.05). The improve rate of JOA scores was (55.78±1.23)% in group A and (54.25±1.48)% in group B at final follow-up, which showed no significant difference between two groups(P>0.05). The increased VAS score was 1.10±0.31 in group A and 1.20±0.27 in group B after opertation, which showed no significant differences between two groups(P>0.05). The VAS score was 2.13±0.16 at final follow-up and 3.23±1.28 at preoperation in group A, which showed significant difference(P<0.05). The VAS score was 2.07±0.21 at final follow-up and 3.35±1.15 at preoperation in group B, which showed significant difference(P<0.05). 1 case suffered from severe axial symptoms in each group, 2 cases in group B were noted C5 palsy, all relieved after treatment. The cervical curvature angle was preoperative(16.5°±4.1°) and postoperative(16.3°±5.7°) in group A, and preoperative(15.8°±5.2°) and postoperative(15.6°±6.6°) in group B, which showed no significant differences between preoperative and postoperative cervical curvature angle in both groups(P>0.05). The angle of the opened laminae was 45.6°±3.6° in group A and 48.4°±5.4° in group B at final follow-up, which showed significant difference(P<0.05). The decreased range of motion was 5.78°±4.35° in group A and 5.91°±3.16° in group B at final follow-up, which showed no significant difference(P>0.05). Conclusions: Both Vertex rod-screw system and Centerpiece plate-screw system are effective in cervical expansive open-door laminoplasty for multilevel cervical spondylotic myelopathy, but the former can decrease the incidence of postoperative C5 nerve palsy.