不同内固定对单开门扩大成形术后轴性症状并发症影响  

Influence on postoperative axial symptom by unilateral laminoplasty combined with different fixations

作　　者：巩腾 苏学涛[1] 夏群[1] 王景贵[1] 阚世廉[2] 

机构地区：[1]武警后勤学院附属医院骨科中心脊柱科,天津300162 [2]天津医院,天津300211 [3]天津医科大学,天津300070

出　　处：《医疗卫生装备》2017年第12期65-69,共5页Chinese Medical Equipment Journal

基　　金：天津市科委自然科学基金(043609011);武警后勤学院博士启动金(WYB201109)

摘　　要：目的:观察术前合并生理曲线异常和不同内固定对椎间关节硬化型颈椎病患者后路单开门扩大成形术后轴性症状(postoperative axial symptom,PAS)和门轴侧骨槽融合率的影响。方法:选取106例接受颈椎管后路减压的脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者,其中辅助椎弓根钉棒固定48例、侧块钉棒固定58例,均随访3 a以上,分别比较术前有、无生理曲线异常时,行单开门扩大成形联合侧块或椎弓根钉棒固定术后6个月门轴侧骨槽融合率,PAS发生率、首发时间、严重程度和持续时间。结果:50例术前无生理曲线异常患者,椎弓根置钉术后6个月门轴侧骨槽融合率高于侧块钉棒固定患者,差异有统计学意义(t=142.2,P=0.032),椎弓根置钉PAS持续时间短于侧块钉棒固定患者,差异有统计学意义(t=147.2,P=0.019);56例术前有生理曲线异常患者,椎弓根固定PAS发作率低于侧块钉棒固定患者,差异有统计学意义(χ~2=3.89,P=0.042)。结论:CSM患者行颈椎管后路单开门扩大成形联合椎弓根钉棒固定,可在一定程度上促进门轴侧骨槽融合,缩短PAS病程,降低PAS发生率。Objective To observe the influence of preoperatively physical curvature abnormality and different fixation systems on postoperative axial symptom(PAS) and union rate of hinge groove after unilateral expansive laminoplasty for the patient with cervical spondylotic myelopathy(CSM). Methods The study reviewed 106 CSM patients who underwent unilateral laminoplasty supplemented by lateral mass or pedicle screw/rod fixation with a minimum of 36 months of follow-up.According to being complicated with physical curvature abnormality or not, the incidence, initial onset, severity, duration of PAS and union rate of hinge groove at postoperative 6 months were respectively compared to analyze the influences of two internal methods on the features of PAS. Results For 50 cases without physical curvature abnormality, fusion rates of hinge groove in pedicle placement group was higher than that in lateral mass fixation group, the P value reached statistical difference(t=142.2, P=0.032). Duration of PAS in pedicle group was shorter than that in lateral mass group, the difference reached statistic significance(t=147.2, P=0.019). For 56 cases of with physical curvature abnormality, incidence of PAS in pedicle group presented was lower than that in lateral mass group, the difference achieved statistic significance( χ~2=3.89, P=0.042). Conclusion Whether concomitant with physical curvature abnormality or not, pedicle fixation would be beneficial to promoting bony fusion of hinge groove, shortening duration of PAS and reducing incidence of PAS in contrast to lateral mass fixation to some extent after unilateral laminoplasty for treating CSM patients.

关 键 词：术后轴性症状 单开门扩大成形 颈椎不稳 椎间关节硬化型颈椎病 椎弓根钉棒 侧块钉棒 

分 类 号：R687.3[医药卫生—骨科学]