Centerpiece钢板在颈椎单开门术中应用价值  

Centerpiece plating in the cervical single open-door laminoplasty

作　　者：吴忠伟[1] 任少军[1] 盛孝永[1] 李松强[1] 朱科军[1] 何登伟[1] 

机构地区：[1]温州医学院附属丽水市中心医院脊柱外科,浙江丽水323000

出　　处：《中国骨伤》2013年第3期252-256,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:评价Centerpiece钢板在颈椎单开门术中应用价值及相对于传统丝线缝合固定方法的优缺点。方法:自2009年12月至2011年8月,采用手术治疗脊髓型颈椎病32例,其中采用颈后路单开门椎板成形术加Center-piece钢板内固定治疗15例(A组),男8例,女7例;年龄51～65岁,平均60.5岁;病程2～15个月。采用传统颈椎椎管单开门扩大成形术(丝线缝合固定)治疗17例(B组),男9例,女8例;年龄49～66岁,平均61.5岁;病程1～14个月。两组患者术前均存在不同程度的行走不稳症状,颈椎MRI上可见颈髓受压明显伴有脊髓变性。按日本矫形外科学会(JOA)评分法分别在术前和术后6个月对患者脊髓神经功能进行评分,测定患者术前及术后CT上椎管矢状径(AP)及颈椎活动度(ROM)。结果:32例患者均获得随访,时间8～20个月,平均13个月。所有切口愈合良好,未出现内固定松动、断裂及脊髓损伤加重等并发症。术后症状均明显恢复,复查MRI、颈椎CT见椎管容积明显扩大,术后随访无再关门及钢板螺钉松动的异常情况。A组平均手术时间、出血量分别为(155±12.3)min、(407±11.8)ml;B组平均手术时间、出血量分别为(148±14.4)min、(398±15.4)ml,两组比较均无统计学意义(P>0.05)。JOA评分A组由术前的9.1±2.6提高到术后的15.5±1.8,B组由术前的9.3±2.1提高到术后的13.1±2.5,差异均有统计学意义(P<0.05)。椎管矢状径(AP)A组由术前的(10.7±2.4)mm提高至术后的(17.6±3.2)mm;B组由术前的(11.6±1.7)mm提高至术后的(15.9±2.0)mm,差异均有统计学意义(P<0.05)。颈椎活动度(ROM)A组手术前后分别为(51.0±2.6)°和(45.0±3.5)°,B组分别为(52.0±1.8)°和(42.0±2.4)°,两组术前颈椎活动度差异无统计学意义(P>0.05),术后颈椎活动度差异有统计学意义(P<0.05)。结论:颈后路单开门椎板成形术加Centerpiece钢板内固定治疗脊髓型颈椎病相对于传统颈椎椎管单开门扩大成形术(丝线缝合固定),Objective ：To evaluate the value of the Centerpiece plate in the cervical single open-door laminoplasty and compared its advantages with conventional suture fixation methods. Methods ：From December 2009 to August 2011,32 pa- tients with cervical spondylotic myelopathy were treated with operation, Of them, 15 cases underwent cervical single open-door laminoplasty and Centerpiece plate fixation （group A） ,there were 8 males and 7 females ,aged fi＇om 51 to 65 years old with an average of 60.5 years and ranged in course of disease from 2 to 15 months; 17 cases underwent cervical single open-door laminoplasty and silk suture fixation Cgroup B） ,there were 9 males and 8 females,aged from 49 to 66 years old with an average of 61.5 years and ranged in course of disease from 1 to 14 months. All the patients with unsteady gait symptom before operation and cervical MR imaging showed spinal cord compression and denaturation. According to standard of Japanese Orthopaedics Association （JOA） to evaluate the spinal nervers function before operation and at 6 months after operation;according to CT scan to determine the sagittal diameter CAP） of upper vertebral canal and cervical activity （ROM）. Results：All the patients were followed up from 8 to 20 months with an average of 13 months. All the incisions healed well and no complications such as internal fixation loosening and breakage, spinal cord injury, reclose-door were found. Postoperative symptoms relieved obvious- ly and MRI and CT showed vertebral canal volume expanded significantly. Operative time and blood loss in group A were re- spectively （ 155.0± 12.3 ） min, （ 407.0± 11.8 ） ml and in group B were respectively （ 148.0± 14.4 ） rain, （ 398.0± 15.4 ） ml. There was no significantly difference between two groups （P〉0.05）. JOA score in group A improved from preoperative 9.1±2.6 to postoperative 15.5±1.8 and in group B improved from preoperative 9.3± 2.1 to postoperative 13.1 ± 2.5 （P〈0.05）. CT sagittal diameter CAP）

关 键 词：颈椎病 Centerpiece钢板 椎管 单开门扩大成形术 

分 类 号：R681.55[医药卫生—骨科学]