颈椎后路单开门加微型钛板内固定术治疗多节段脊髓型颈椎病的临床疗效观察  

Use of titanium miniplate in cervical single open-door laminoplasty for multiple-segment cervical spondylotic myelopathy

作　　者：祖波[1] 章小军[1] 郑毅[1] 

机构地区：[1]安徽医科大学附属安庆医院骨科,安庆246003

出　　处：《南通大学学报（医学版）》2014年第3期196-198,共3页Journal of Nantong University(Medical sciences)

摘　　要：目的：探讨颈椎后路单开门椎管扩大成形术加微型钛板内固定治疗多节段脊髓型颈椎病的临床疗效。方法：选择2011年10月-2013年4月本院收治的脊髓型颈椎病15例，所有患者术前均经临床症状、X线、CT及MRI表现诊断，患者均采用颈椎后路单开门椎管扩大成形术，开门侧均使用微型钛板内固定治疗，观察术中和术后并发症发生情况，比较手术前后日本矫形外科协会（Japanese Orthopaedic Association，JOA）评分、神经功能改善率及颈椎曲度变化。结果：所有患者均顺利接受手术，手术时间70～130 min，平均85 min，术中出血量150～500 mL，平均250 mL。术中无不可逆性脊髓损伤，无脑脊液漏、切口感染、内固定断裂等并发症发生，2例患者术后出现轴性症状。随访6～20个月，平均13.4个月，JOA评分由术前平均（8.6±1.7）分提高到术后平均（13.8±2.1）分，所有患者神经功能均得到不同程度改善，神经功能改善率为28.3％～75.6％，平均（53.8±17.9）％，术后颈椎曲度为17.9°±3.8°，与术前18.1°±4.0°比较差异无统计学意义。末次随访未发现再关门现象。结论：颈椎后路单开门加微型钛板内固定术是治疗多节段脊髓型颈椎病的一种安全有效的方法。Objective：To explore the clinical efficacy of use of titanium miniplate in cervical single open-door laminoplasty for the treatment of multiple-segment cervical spondylotic myelopathy. Methods： 15 patients who stayed in our hospital were selected from October 2011 to April 2013 and diagnosed of femoral shaft fracture by clinic,X-rays,CT and MRI. All patients were underwent single open-door laminoplasty, open-door side were fixed using titanium miniplate. Surgical complications were recorded. The JOA score, improvement rate and alignment of the cervical spine were analyzed preoperative and postop-erative respectively. Results： All the patients underwent the operation. The average surgery time was 85 min ranging from 70 to 130 min. The average blood loss was 250 mL ranging from 150 to 500 mL. No complication such as irrevisible neurological injury, cerebrospinal fluid leakage, infection and break of internal fixation was noted. There were 2 patients with the occur-rence of axial symptoms. All patients were followed up 6 months to 20 months（mean, 13.4 months）, the average JOA score was increased from 8.6 ±1.7 to 13.8 ±2.1. The patients with postoperative neurological deficit improved to different degrees. The JOA improvement rate was 28.3%-75.6%, with a mean of （53.8 ±17.9）%. There was no significant difference between preoperative 18.1°±4.0° and postoperative 17.9°±3.8° cervical curvature angle. No door-reclose was noted during follow- up. Conclusion：Use of titanium miniplate in cervical single open-door laminoplasty was one of safe and effective surgical method to treat multiple-segment cervical spondylotic myelopathy.

关 键 词：脊髓型颈椎病 椎管扩大成形术 单开门 微型钛板 

分 类 号：R681.5[医药卫生—骨科学]