Cervifix颈椎后路杆固定系统垂直水平悬吊改良单开门椎管成形术  

Application of modified open door laminoplasty by Cervifix fixation and vertical horizontal sling

作　　者：蓝树华[1] 叶方[1] 池永龙[2] 柳育健[1] 吕国强[1] 应锦和[1] 吴泉州[1] 

机构地区：[1]丽水中心医院骨科,浙江丽水323000 [2]温州医学院

出　　处：《中国骨伤》2006年第8期464-466,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的：评价Cervifix固定垂直水平悬吊改良单开门椎管成形术的疗效。方法：35例颈椎病患者，男23例，女12例；年龄47—68岁，平均56．4岁；34例为脊髓型颈椎病，1例为颈椎术后翻修；椎管矢状径4．6—9．3mm；椎管矢状面狭窄率达39％-84％，平均49．3％；减压节段C3-C5 9例，C3-C6 20例，C4-C7 6例。常规行后正中人路单开门椎管成形术，在所减压的节段侧块上Cervifix固定，采用Roy-Camille置人侧块螺钉。先用磨钻在所减压节段的棘突根部开预穿孔，开门后穿粗丝线于Cervifix的纵连杆拉紧并打结，行水平方向固定。垂直方向在开门侧的椎板上打预穿孔，用“斜拉桥”原理悬吊于临近未减压的棘突上加固。使椎板保持在开门状态。术后颈围领保护3个月。结果：35例平均随访15个月（7-18个月）。术前JOA评分平均8．0分，术后平均15．7分。术后3个月复查CT及X线片未见螺钉松动和再关门现象。仅有3例诉颈部有僵硬感，局部无疼痛。肌电图及体感诱发电位、感觉运动传导速度基本接近正常。6个月后僵硬感基本消失。结论：Cervifix固定垂直水平悬吊改良单开门椎管成形术操作简单、安全，维持开门效果好。术后患者颈部症状恢复快、效果满意，是治疗多节段颈椎病及颈椎管狭窄症的一种有效可行的方法。Objective： To evaluate the clinical outcome of modified open door laminoplasty by Cervifix fixation and vertical horizontal sling. Methods- Thirty-five patients of cervical syndrome included 23 male and 12 female; The average age was 56.4 years ranging from 47 to 68 years. Of all the patients, 34 were cervical spondylotic myelopathy and the other one was reoperation after cervical operation. The sagittal diameter of vertebral canal was from 4.6 to 9.3 mm, the stenosis ratio of sagittal plane from 39% -84% （mean 49.3% ）. The decompression segment were C3 to C5 in 9 cases, C3 to C6 in 20 cases, C4 to C7 in 6 cases. A routine posterior midline approach and Cervifix fixation were used in the open door laminoplasty. Roy-Camille technique was used for the insertion of lateral mass screw on hinge side. While the ＂door＂ was opened, each lamina was suspended through the hole in the base of spinous process （prefabricated with bone drill） to the longitudinal pitman of ＂Cervifix＂ with thick silk thread to achieve the horizontal fixation. The other prefabricated hole on the lamina of the open door side was used to suspend the lamina to the adjacent spinous process which was not decompressed to remain the door in the opening position. Soft collar protection was applied for three months after the operation. Results： Thirty-five patients were followed up for from 7 to 18 months （mean 15 months）. The average preoperative JOA score was 8.0 and postoperative JOA score was 15.7. No screw loosening and door re-closure was found in the CT and X-ray film three months after the operation. Only 3 cases had stiffness in the neck but no neck pain. The electromyogram, somatosensory evoked potential （SEP） and nerve conduction velocity were close to normal. The neck stiffness disappeared after six months after the operation. Conclusion： This modified open door laminoplasty by Cervifix fixation and vertical horizontal sling has advantages of easy performing, safety, good maintaining of elevated lamina, less neck s

关 键 词：颈椎病 内固定器 外科手术 

分 类 号：R681.55[医药卫生—骨科学]