单开门与全椎板切除治疗多节段脊髓型颈椎病疗效比较  

Comparison of the Single Expansive Open-door Laminoplasty with Miniature Plate Internal Fixation and the Total Laminectomy with Lateral Mass Screw Internal Fixation in Treatment Multi-Segmental Cervical Spondylotic Myelopathy

作　　者：马亮[1] 许永涛[1] 佘远举[1] 

机构地区：[1]湖北省荆州市中心医院骨3科,湖北荆州434020

出　　处：《实用骨科杂志》2015年第11期975-978,共4页Journal of Practical Orthopaedics

摘　　要：目的比较单开门微型钢板固定与全椎板切除侧块螺钉固定治疗多节段脊髓型颈椎病的疗效。方法回顾性分析2010—2014年我科开展的27例颈椎后路单开门微型钢板固定椎管成形术和24例后路全椎板切除侧块螺钉固定术治疗多节段脊髓型颈椎病的患者。比较两组手术时间、出血量、术后颈椎活动度、JOA评分、轴性症状。结果两组手术时间、出血量差异无统计学意义。术后15个月时两组颈椎活动度分别为(40.4±11.27)°,(32.3±10.19)°,差异有统计学意义。两组患者在术后3个月JOA评分分别为(12.17±1.45)分、(11.89±1.87)分,术后15个月时分别为(13.77±0.93)分、(12.95±0.89)分,与术前相比差异有统计学意义,两组间比较差异无统计学意义。两组术后轴性症状发生率分别为14.8%、29.1%,差异有统计学意义。结论此两种手术方式均能有效改善患者的神经症状,但单开门微型钢板固定能更好的保留颈椎活动度,术后轴性症状发生率低。Objective To compare the long-term efficacy and complications between the single expansive open-door laminoplasty with miniature plate internal fixation and the total laminectomy with lateral mass screw internal fixation in treat-ment multi-segmental cervical spondylotic myelopathy. Methods We retrospectively analyzed the clinical data of 51 patients from 2010 to 2014 who had posterior cervical surgery in our department. Group A had 27 cases cervical posterior single open-door laminoplasty with mini plate internal fixation and group B had 24 cases total laminectomy and lateral mass screw fixation. We compared the operation time,bleeding volume,the ranges of cervical movement（ROM）,the JOA score and the axial symp-toms after operation between these two groups. Results There was no significant difference between the operation time,bleed-ing volume. The ranges of cervical movement of two groups were（40. 4 ± 11. 27）°,（32. 3 ± 10. 19）°15 months after operation, the difference was statistically significant. The JOA score in two groups were（12. 17 ± 1. 45）,（11. 89 ± 1. 87）three months after operation and（13. 77 ± 0. 93）,（12. 95 ± 0. 89）fifteen months after operation. The JOA score between preoperative and postoperative was statistically significant,there was no significant difference between two groups. The incidence of axial symp-toms in two group were 14. 8% ,29. 1% . The difference was statistically significant. Conclusion These two opreation can ef-fectively improve the patient＇s neurological symptoms. The single expansive open-door laminoplasty with miniature plate inter-nal fixation can retain more ranges of cervical movement and get low incidence of axial symptoms.

关 键 词：多节段 脊髓型颈椎病 单开门 全椎板切除 微型钢板 侧块螺钉 

分 类 号：R681.55[医药卫生—骨科学]