颈后路椎管扩大减压微型钛板固定椎板成形术与传统颈椎后路单开门椎管扩大减压术治疗颈椎病的比较研究  

Comparison of operative result of using of titanium miniplate in cervical expansive open- door laminoplasty with conventional cervical expansive open- door laminoplasty in treating multi- segment cervical spondylotic myelopathy

作　　者：韦敏克[1] 尹东[1] 梁斌[1] 丘德赞[1] 韦建勋[1] 欧裕福[1] 

机构地区：[1]广西壮族自治区人民医院骨科,南宁530021

出　　处：《中国矫形外科杂志》2014年第19期1751-1755,共5页Orthopedic Journal of China

基　　金：广西壮族自治区卫生厅计划课题资助项目(编号:桂卫Z2013335)

摘　　要：[目的]比较观察研究颈后路椎管扩大减压微型钛板固定椎板成形术与传统颈椎后路单开门椎管扩大减压术治疗颈椎病的临床疗效。[方法]回顾分析32例脊髓型颈椎病患者的临床资料,按手术方式随机分为2组,其中观察组为微型钛板组16例,对照组为传统单开门组16例,对比分析两组患者手术情况、术后症状改善情况JOA评分,末次随访术后椎板开门角度,术后测量颈椎曲度（颈椎侧位X线片上C2与C7椎体后壁切线之间夹角）的改变,以及轴性症状发生率,观察手术时间、术中出血量对比情况。[结果]经术后6个月~2年的随访,微型钛板固定组术后6个月JOA评分改善率为60.5%±17.0%,传统单开门组为58.2%±9.5%,两组比较差异无统计学意义（P〉0.05）。微型钛板固定组末次随访时椎板开门角度为（42.3±3.5）°,传统单开门组为（39.5±4.1）°,两组比较差异无统计学意义（P〉0.05）。微型钛板固定组术后6个月颈椎曲度为（18.5±4.8）°,与术前（18.2±4.8）°比较差异无统计学意义（P〉0.05）;传统单开门组术后6个月颈椎曲度为（16.9±5.6）°,与术前（19.5±6.2）°比较差异有统计学意义（P〈0.05）;微型钛板固定组术后6个月轴性症状发生率为4/16,明显低于传统单开门组的9/16,两组比较差异有统计学意义（P〈0.05）;两组患者无1例出现C5神经根麻痹。[结论]颈后路椎管扩大减压微型钛板固定椎板成形术和传统颈椎后路单开门椎管扩大减压术均是治疗脊髓型颈椎病的有效方法,但颈后路椎管扩大减压微型钛板固定椎板成形术更有效防止单开门椎管扩大椎板成形术后再关门,减少术后轴性症状的发生率和颈椎曲度的丢失,是治疗颈椎病的一种理想手术方式。[ Objective ] To compare the clinical results of titanium miniplate in cervical expansire open - door laminoplasty with conventional cervical expansire open - door laminoplasty. [ Methods] With the methods of retrospective study the clinical statistics, 32 patients with multi -segment cervical spondylotic myelopathy were randomly divided into two groups, one with 16 patients were the group of observation using titanium miniplate and the other were the controlled group with conventional discecto- my. We evaluated the results by the method of JOA, the angle of the opened laminae was measured on CT scan at final follow - up , incidence of axial symptoms were recorded, the cross angle between posterior vertebral body margins of C2 and C7 on cervi- cal radiographs, the operation time, the blood loss and so on were recorded. [ Results ] Follow up ranged 6 - 24 months （aver- age 10 ±3. 1 months） in two groups. The improve rate of JOA scores was 60. 5% ± 17.0% in the observated group and 58.2% ± 9. 5% in the controlled group at six months after operation, which showed no significant diferences between two groups （P 〉 0. 05）. The angle of the opened laminae was （42. 3 ± 3.5） for cases in the observated group and （39.5 ± 4. 1 ） for in the con-trolled group. It showed no significant diference （P 〉 0. 05 ） . There was no significant diference between preoperative （ 18. 5 ± 4. 8） and postoperative （ 18.2 ±4. 8） cervical curvature angle in the observated group, whereas the mean value of postoperative angle （16. 9±5.6） was significantly smaller than that of preopera-tive one （ 19. 5 ± 6. 2） in the controlled group at three months follow - up （ P 〈 0. 05 ） . The incidence of axial symptoms （ 4/ 16） in the observated group was significantly lower than that （9/16） in the controlled group at three months after operation （P 〈 0.05 ） . Two cases in the controlled group presented with C5 nerve root palsy. There were no significant differences with regard to operation

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：R687.3[医药卫生—骨科学]