微型钛板与改良锚定法在颈椎管扩大成形术中应用的早期疗效观察  

Early clinical effects of microplate fixation in open-door cervical expansive laminoplasty by comparing with modified anchor fixation

作　　者：张绍文[1,2] 李盛华[1] 樊成虎[1] 唐晓栋[1] 

机构地区：[1]甘肃省中医院脊柱骨一科,甘肃兰州730050 [2]天津中医药大学,天津300193

出　　处：《临床骨科杂志》2013年第3期241-243,247,共4页Journal of Clinical Orthopaedics

摘　　要：目的对比微型钛板与改良锚定法在单开门颈椎管扩大成形术中的早期临床疗效。方法对135例脊髓型颈椎病患者行颈椎单开门椎管扩大椎板成形术,75例使用微型钛板行"开门"侧固定(A组),60例采用改良锚定法悬吊"门轴"(B组),对两组各项指标进行比较。结果两组手术时间和术中出血量差异均无统计学意义(P>0.05)。两组均随访3个月。3个月时JOA评分改善率:A组为58.3%±10.0%,B组为57.1%±9.2%,差异无统计学意义(P>0.05)。术后3个月时轴性症状发生率:A组为37%(28/75),略低于B组的42%(25/60),但差异无统计学意义(P>0.05)。术后3个月时颈椎曲度:A组为19.1°±5.6°,与术前18.5°±5.8°比较差异无统计学意义(P>0.05);B组为17.3°±5.4°,与术前19.2°±5.3°比较差异有统计学意义(P<0.05)。术后3个月时椎板开门角度:A组为43.2°±4.5°,B组为39.1°±4.7°,差异无统计学意义(P>0.05)。颈椎总活动度改善率:A组为82.36%,B组为74.59%,差异无统计学意义(P>0.05)。结论微型钛板内固定和改良锚定悬吊均可以有效防止单开门椎管扩大椎板成形术后再关门,微型钛板法可获得术后即刻牢靠稳定性,利于患者早期功能锻练,减少颈椎曲度的丢失。Objective To observe early clinical effects of microplate fixation in open-door cervical expansive lamin- oplasty （ELP） by comparing with modified anchor fixation. Methods A total of 135 cases with multi-segment cervi- cal spondylotic myelopathy（ MCSM ） underwent open-door ELP and were followed up in our hospital. 75 patients un- dergoing ELP by microplate fixation were classified as group A ,while 60 patients undergoing ELP by modified anchor fixation as group B. Results Two groups were followed up for 3 months on average. There were no significant differ- ences with regard to operation time and blood loss between two groups（ P 〉 0. 05 ）. The improvement rate of Japanese Orthopaedic Association（JOA） scores were 58.3% ± 10. 0% in group A and 57. 1%± 9. 2% in group B three months post-operation, which showed no significant differences between two groups （ P 〉 0. 05 ）. The incidence of axial symptoms （28/75） in group A was somewhat lower than that （25/60） in group B at three months after operation （P 〉0. 05）. There was no significant difference between preoperative（19. 1° ±5.6°） and postoperative（18.5° ±5.8°） cervical curvature angle in group A, whereas the mean value of postoperative angle（ 17.3° ± 5.4°） was significantly smaller than that of preoperative one（ 19.2° ±5.3°） in group B at three months follow-up（P 〈0. 05）. The angle of the opened laminae was 43.2° ±4. 5° for group A and 39. 1° ±4. 7° for group B,which showed no significant differ- ence（P 〉0. 05）. Improvement rate of the range of motion（ROM） of group A （82. 36% ） was somewhat higher than that 74. 59% in group B at three months after operation （P 〉 0. 05 ）. Conclusions Both surgical protocols are effec- tive on preventing reclose of opened laminae, moreover ELP by microplate fixation can achieve the stability quickly af- ter operation, which can help patients to do functional exercises early, and is superior on reducing the loss of cervical curvature.

关 键 词：颈椎病 椎管扩大椎板成形术 单开门 微型钛板 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]