单开门颈椎管扩大成形Centerpiece钛板内固定术治疗脊髓型颈椎病的中期临床疗效

Mid-term clinical efficacy of unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation for cervical spondylotic myelopathy

中文关键词:  脊髓型颈椎病  单开门颈椎管扩大成形术  Centerpiece 钛板  内固定  疗效

英文关键词:Cervical spondylotic myelopathy  Unilateral open-door cervical expansive laminoplasty  Centerpiece titanium plate  Internal fixation  Efficacy

中文摘要:

  【摘要】 目的：探讨单开门颈椎管扩大成形Centerpiece钛板内固定术治疗脊髓型颈椎病的中期临床疗效。方法：选择2009年1月～2011年6月在我院行后路椎管扩大成形Centerpiece钛板内固定术治疗的脊髓型颈椎病患者59例，其中男性42例，女性17例，年龄21～68岁，平均56.2±9.8岁。MRI显示3个节段狭窄12例，4个节段狭窄29例，5个节段狭窄18例。以日本骨科协会（JOA）评分（17分法）及其改善率评价术后神经功能改善情况；视觉模拟评分（visual analogue scale/score，VAS）及颈部功能障碍指数（neck dysfunction index，NDI）评价患者的疼痛及功能变化情况；术后复查颈椎X线、CT及MRI，在术前及末次随访时的颈椎X线片上测量C2～C7夹角、颈椎活动度（ROM），在颈椎三维CT上测量椎管矢状径及椎管横截面积，计算椎管扩大率[（术后椎管矢状径-术前椎管矢状径）/（术前椎管矢状径）×100%]，评价椎管扩大和维持情况及门轴侧骨融合情况。结果：手术时间为142.2±18.1min，术中出血量为264.5±50.5ml，术后引流量为252.3±28.6ml，住院日为7.2±0.7d。在术后随访过程中，15例出现了颈后部轴性疼痛症状，按照VAS评分，13例为轻度疼痛，2例为中度疼痛，所有患者颈部轴性疼痛症状均于术后1年内消失。1例术后第3天出现C5神经根麻痹症状，经2周保守治疗症状明显缓解，于术后12周时症状完全消失。随访48～72个月，平均60.5±2.7个月，术前JOA评分为8.5±0.5分，末次随访为15.4±1.3分，改善率为（77.1±5.2）%。术前平均VAS评分为3.9±0.4分，末次随访时为1.3±0.6分。术前平均NDI为20.3±5.4，末次随访时为6.5±1.8。影像学复查示术后随访期间颈椎管扩大满意，脊髓受压完全解除，椎管矢状径平均值术前为9.7±0.9mm，末次随访时为16.8±1.2mm，椎管扩大率为（67.6±13.9）%，椎管矢状面积术前为128.1±13.5mm2，末次随访时为318.3±34.3mm2。末次随访时颈椎ROM值较术前减少9.6°±2.4°，手术前与术后随访期间C2～C7夹角未见明显差异（P＞0.05）。术后6个月门轴侧均达骨性愈合，随访期间均未出现关门及神经损害症状加重的情况。结论：单开门颈椎管扩大成形Centerpiece钛板内固定术是治疗脊髓型颈椎病的一种简便、安全的方法，中期临床疗效较满意。

英文摘要:

  【Abstract】 Objectives: To evaluate the mid-term clinical efficacy of unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation for cervical spondylotic myelopathy. Methods: From January 2009 to June 2011, 59 cases suffering from cervical spondylotic myelopathy underwent unilateral open-door expansive laminoplasty plus centerpiece fixation, among these, there were 42 males and 17 females, with a mean age of 56.2±9.8 years（range, 21-68 years）. Preoperative MRI showed stenosis at three levels in 12 cases, four levels in 29 and five levels in 18. The neurological function was evaluated by Japanese Orthopaedic Association(JOA) score. The VAS(visual analogue score) and NDI(neck disability index) were used to evaluate the pain severity and function. X-ray, CT and MRI were used to evaluate postoperative spinal canal enlargement and bone fusion at the hinge side. The mean sagittal diameter of spinal canal on sagittal CT, cervical range of motion(ROM) and the C2－C7 Cobb angle on lateral X-ray were measured before opera?鄄tion and the final follow-up after operation respectively, and the expansion rate of spinal canal was counted [as(postoperative sagittal diameter-preoperative sagittal diameter)/(preoperative sagittal diameter)×100%]. Results: The average operation time was 142.2±18.1min; the average intraoperative blood loss was 264.5±50.5ml; the drainage volume was 252.3±28.6ml; the discharge time was 7.2±0.7 days. Axial neck pain after surgery was observed in 15 patients. According to VAS score, 13 cases got slight pain and 2 cases with moderate pain. Axial neck pain was relieved at one year postoperatively in all 15 patients. C5 palsy was noted in 1 case at 3 day after operation, which was relieved significantly after 2 weeks of correspondent intervention and resolved completely 12 weeks after operation. All patients were followed up for 48-79 months(mean 60.5±2.7 months). The average JOA score at preoperation was 8.5±0.5 and 15.4±1.3 at final follow-up after operation, with the improvement rate of (77.1±5.2)%. The average VAS score at preoperation was 3.9±0.4 and 1.3±0.6 at final follow-up after operation. The average NDI score for preoperation was 20.3±5.4 and 6.5±1.8 at final follow-up after operation. Radiographic findings showed spinal canal enlarged perfectly at follow-up period after operation, and Spinal cord compression was completely lifted. The mean sagittal diameter of C2-C7 spinal canal was 9.7±0.9mm before operation and 16.8±1.2mm at final follow-up after operation, with the expansion rate of （67.6±13.9）%. The mean cross-sectional area was 128.1±13.5mm2 before operation and 318.3±34.3mm2 at final follow-up after operation. ROM decreased by 9.6°±2.4° at final follow-up and the C2-C7 Cobb angle decreased slightly in all patients without statistic difference(P＞0.05). CT scan showed bony fusion at the hinge side at 6 months after operation without recurrence of cervical stenosis and neurofunction deterioration. Conclusions: Unilateral open-door expansive laminoplasty plus centerpiece titanium plate fixation for cervical spondylotic myelopathy is simple and reliable, and the mid-term clinical efficacy is satisfactory.