颈椎单开门椎管扩大成形术不同椎板固定方法治疗多节段脊髓型颈椎病的疗效分析

Posterior cervical laminoplasty by using two different vertebral plates for multi segmental cervical spondylotic myelopathy

中文关键词:  脊髓型颈椎病  椎管扩大成形术  微型钛板固定  丝线悬吊  疗效

英文关键词:Cervical spondylotic myelopathy  Cervical laminoplasty  Internal Fixators  Silk thread suspension  Clinical effect

中文摘要:

  【摘要】 目的：分析颈椎单开门椎管扩大成形术不同椎板固定方法治疗多节段脊髓型颈椎病的临床效果。方法：2007年1月~2011年1月采用颈椎后路单开门椎管扩大成形术治疗并获得随访的多节段脊髓型颈椎病患者92例，均采用颈椎后路C3～C7单开门椎管扩大成形术，根据椎板固定方式分为两组：A组，采用丝线悬吊椎板，49例，男37例，女12例，年龄58.0±13.6岁，病程11.3±6.7个月；术前JOA评分8.23±1.21分，颈椎曲度18.2°±6.4°，VAS评分4.46±1.64分。B组采用微型钛板固定椎板，43例，男32例，女11例，年龄56.6±14.7岁，病程10.9±8.5个月，术前JOA评分8.12±1.56分，颈椎曲度17.9°±8.3°，VAS评分为4.65±1.12分。记录两组手术时间、术中出血量、术后引流量，随访两组患者神经功能改善情况、颈椎曲度及轴性症状等，并进行比较。结果：两组手术时间、术中出血量、术后引流量无显著性差异（P＞0.05）。A组7例、B组8例出现肩部放射痛，给予脱水剂、物理治疗等治疗1周后消失，两组均未出现C5神经根麻痹。随访24～47个月，平均38个月，术后12个月随访时两组神经功能均明显改善，A组JOA评分为14.57±2.95分、改善率为72.29%，B组JOA评分为14.31±2.86分、改善率为69.48%，两组比较无显著性差异（P＞0.05）；术后12个月A组颈椎曲度为15.9°±5.7°，B组为18.1°±7.9°，差异有显著性（P＜0.05）。术后3个月时A组VAS评分为2.12±1.92分，B组为1.82±0.64，两组比较无显著性差异；12个月时A组VAS评分为1.32±0.88分，B组为0.79±0.53，两组比较有显著性差异（P＜0.05）。随访期间两组均无再关门发生，B组无钛板、螺钉松动移位。结论：颈椎单开门椎管扩大成形术采用丝线悬吊与微型钛板固定椎板均能有效维持椎管的扩大状态，取得较好临床疗效，但微型钛板可减轻术后远期颈部疼痛不适症状，并有利于颈椎曲度的维持。

英文摘要:

  【Abstract】 Objectives: To investigate the outcomes of posterior cervical laminoplasty by using two different vertebral plates for multi segmental cervical spondylotic myelopathy. Methods: From January 2007 to January 2011, 92 patients with multi segmental cervical spondylotic myelopathy undergoing posterior C3-C7 single door laminoplasty were followed up, all patients were divided into two groups: group A, laminoplasty by using silk thread suspension, 49 cases(37 males and 12 females) with the age of 58.0±13.6 years, course of disease of 11.3±6.7 months, preoperative JOA score of 8.23±1.21, cervical curvature of 18.2°±6.4°, VAS score of 4.46±1.64; group B, laminoplasty by using mini titanium plate, 43 cases(32 males and 11 females) with the age of 56.6±14.7 years, course of disease of 10.9±8.5 months, preoperative JOA score of 8.12±1.56, cervical curvature of 17.9°±8.3°, VAS score of 4.65±1.12. The operation time, blood loss during operation, postoperative drainage, follow-up results, cervical curvature and axial symptoms were recorded and compared between 2 groups. Results: The operation time, blood loss, postoperative volume showed no significant difference between 2 groups(P>0.05). 7 cases in group A and 8 cases in group B presented with radiative pain in shoulder, which resolved after dehydrate medication, physical therapy and other treatments in 1 week, all patients had no C5 nerve root palsy. Patients were followed up for 24-47 months, with an average of 38 months. 12 months after operation, neurofunction improved significantly in group A, the JOA score was 14.57±2.95, with the improvement rate of 72.29%; while in group B, the postoperative JOA score was 14.31±2.86, with the improvement rate of 69.48%, which showed no significant difference(P>0.05) between 2 groups; the cervical curvature in group A after 12 months was 15.9°±5.7°; while that in group B was 18.1°±7.9°, group B had better cervical alignment than group A(P<0.05). The preoperative and postoperative 3 month VAS score showed no difference between 2 groups, but the difference was significant after 12 months(P<0.05), group A had better result than group B. During the follow-up, two groups had no door closed, and no instrument failure was noted in group B. Conclusions: Cervical expansive open-door laminoplasty with either mini titanium plate fixation or silk thread suspension can effectively maintain the spinal canal enlargement and achieve better clinical outcome, but the mini titanium plate can decrease the incidence of postoperative long-term neck pain.