空心钉置入椎管重建术治疗多节段脊髓型颈椎病  

Open-door laminoplasty with cannulated screw for treatment of multi-segments cervical spondylotic myelopathy

作　　者：陆成武 王林锋[1] 叶宏[1] 陈小杰[1] 吴建斌[1] 魏桂财[1] 赖必华[1] 

机构地区：[1]福建省南平市福建医科大学附属南平市第一医院脊柱外科,353000

出　　处：《中国矫形外科杂志》2017年第11期1033-1037,共5页Orthopedic Journal of China

基　　金：福建省南平市科技基金项目(编号:N2015Y03)

摘　　要：[目的]探讨在多节段脊髓型颈椎病后路单开门椎管扩大成形术中应用空心钉重建颈椎管的临床疗效。[方法]2012年2月~2015年10月,对42例多节段脊髓型颈椎病患者行颈椎后路单开门椎管扩大减压术,术中采用空心钉置入重建椎管。其中34例患者获得随访,男21例,女13例,年龄48~72岁,平均63岁。评估手术时间、术中出血量,观察术中和术后并发症发生情况;所有随访的患者均行CT和MRI检查,比较术前及末次随访的JOA评分以及C_5椎管横截面积。[结果]手术时间(135±32)min,术中出血量为(230±46)ml,术中未出现脊髓损伤、脑脊液漏等相关并发症;随访10~28个月,平均14.2个月,影像学评估显示植骨处达骨性愈合,未见空心钉脱落移位及再关门现象。神经功能明显改善,JOA从术前(7.23±2.56)分提高至(13.71±2.40)分,差异有统计学意义(P<0.01),改善率为(69.16±18.21)%;末次随访时C_5椎管横截面积均显著优于治疗前(P<0.01)。[结论]空心钉置入颈椎管重建术可明显改善多节段脊髓型颈椎病患者的神经功能,临床疗效满意;且操作技术安全,可提供即刻的力学支持,提高截骨处的愈合率,可作为多节段脊髓型颈椎病一种手术方式的选择。[Objective] To investigate the clinical outcome of open-door laminoplasty with cannulated screw for the treatment of multi-segments cervical spondylotic myelopathy. [Method] From February 2012 to October 2015, 42 patients with cervical stenosis underwent laminoplasty with cannulated screw. Of them, 34 patients who had been followed up for 10 to 28 months （mean, 14.2 months） were enrolled in this study, including 21 males and 13 females, with an average age of 63 years （range, 48 to 72 years） . The operation time, blood loss and perioperative complication were observed. Additionally the Japanese Orthopaedic Association （JOA） score, and the spinal canal cross-sectional area measured in CT and MR images were compared between pre- and post-operatively. [Result] Lamimoplasty was successfully performed in all of the patients with a mean operative time of （135 ＋32） min and a mean volume of blood loss of （230＋46） ml, in which all cannulated screws were smoothly inserted to keep cervical canal enlargement. No complications, such as screws loosening, lamina collapse or ＂door re-closure＂ were noted in any patient. The JOA scores improved significantly from （7.23±2.56） preoperatively to （13.71±2.40） at the latest follow up （P 〈 0. 01）, with the improvement rate of 69.1%±18.2%. Additionally, the C5 spinal canal cross-sectional area also improved significantly （P〈0.01） . [Conclusion] For multi-segments cervical spondylotic myelopathy, the cannulated screws for fixation of laminoplasty enhance the biomechanical stability and improve bony healing rate. Therefore, it is a choice of surgical techniques.

关 键 词：脊髓型颈椎病 单开门椎管成形术 空心钉 

分 类 号：R687.3[医药卫生—骨科学]