颈椎单开门OsteoMedM3钉板内固定椎管扩大成形术治疗颈椎疾病的疗效分析  

Clinical outcome of expansive unilateral open-door laminoplasty in cervical myelopathy with OsteoMed M3 plate and screws

作　　者：胡孔和[1] 吴强[1] 靳安民[2] 段扬[2] 

机构地区：[1]汕头大学医学院附属粤北人民医院骨科,韶关512026 [2]南方医科大学附属珠江医院骨科,广州510282

出　　处：《国际外科学杂志》2012年第6期373-376,F0003,共5页International Journal of Surgery

基　　金：广东省科技计划项目（No.2011B031300027）

摘　　要：目的回顾性分析颈椎单开门OsteoMed M3钉板内固定椎管扩大成形术后的治疗效果及影响因素。方法选择多节段椎间盘突出并椎管狭窄等颈柞疾病患者26例，行颈椎单开门OsteoMedM3钉板内固定椎管扩大成形手术治疗，术后随访1年以上，应用JOA评分法对术前及术后的脊髓功能改善情况进行对比及评价。对影响术后疗效的相关因素进行分析。结果26例患者术后随访1年以上，术前JOA评分：9．40±1．658（5～13分）分，术后JOA评分：13．80±1．958（7～16分）分，差异有统计学意义（t=-21．137，P=0．000），大部分患者症状明显改善，术后改善率为57．9％。术后X线片、MRI及CT检查提示椎管的矢状径和柞管均明显扩大，3例症状改善不明显的患者，2例二期实施前路减压固定融合术后症状缓解，1例后纵韧带骨化症患者恢复欠佳；无一例出现继发性椎管狭窄引起神经功能变坏或手术相关的并发症。年龄大、病史时间长、病情重、术前合并颈椎后凸畸形及病变部位脊髓MRI信号改变会影响患者的恢复，术后早期行功能锻炼有利于患者的恢复。结论存颈椎单开门椎管扩大成形术中应用OsteoMed M3钉板内固定具有避免开门后再关闭，保持椎管扩大效果，且操作简单，并发症少，费用低廉，适合临床运用。Objective To retrospectively describe the technique and review the surgical results of OsteoMed M3 titanium plate and screws used to secure the posterior elements in the open position after expansive unilateral opendoor laminoplasty. Methods Twenty-six patients with multilevel cervical disc herniation and canal stenosis were treated with an expansive unilateral open-door laminoplasty with OsteoMed M3 plate and screws. The follow-up period was over 1 year. The improvement of spinal function after surgeries under JOA was evaluated to analyse the effects and releated factors. Results All of 26 cases＇ follow-up period was over 1 year. The mean JOA score increased signifi- cantly from 9.40 ±1. 658 （ range, 5 to 13 ） points before surgery to 13.80 ± 1. 958 （ range, 7 to 16） points at final follow- up （ t = - 21.137, P = 0.000 ）. Mean recovery rate was 57.9%. Postoperative radiography, magnetic resonance imaging and computed tomography scan demonstrated significantly increased sagittal diameter and canal expansion. Two cases without relief of nurological symptoms underwent an additional anterior multilevel corpectomy. One case with ossification of the posterior longitudinal ligament had not good enough ueurologic improvement after surgery. No neurologic deterioration owing to hinge reclosure or major surgery-related complications were observed. It would reduce the recovery for those with old age, long history, worse symptoms, cervical kyphosis and abnormal signal in MR imaging. It was good for patients to do early active cervical exercises after surgery. Conclusion Unilateral open-door laminoplasty with OstcoMed M3 titanium plate and screws fixation effectively maintains expansion of the spinal canal and resists closure while preserving alignment and stability. This modified technique is easy to perform with a low complication, is and economic, and is good for clinical application.

关 键 词：颈椎病 椎管扩大成形 内固定 OsteoMed M3 

分 类 号：R687.3[医药卫生—骨科学]