保留C_2棘突止点全椎板减压侧块螺钉固定术治疗累及C_2节段的脊髓型颈椎病疗效观察  

Laminectomy with lateral mass screw fixation and preserve C_2 spinous process for the treatment of cervical spondylotic myelopathy involving C_2 segment

作　　者：徐钦华[1] 王涛[1] 魏凯[1] 尚平福 刘法敬[2] Xu Qinhua;Wang Tao;Wei Kai(Second Department of Orthopedics of Staffand workers Hospital ofHandaniron and steel Refco Group Ltd;Second Department of Orthopedics ofHandan Central Hospital,Handan Hebei,056001,China)

机构地区：[1]邯郸钢铁集团有限责任公司职工医院骨二科 [2]邯郸市中心医院骨二科,河北邯郸056001

出　　处：《生物骨科材料与临床研究》2018年第6期45-48,共4页Orthopaedic Biomechanics Materials and Clinical Study

基　　金：河北省医学科学研究重点课题计划(项目编号:20150452)

摘　　要：目的观察保留C_2棘突止点全椎板切除侧块螺钉固定术在治疗累及C_2水平的脊髓型颈椎病临床疗效。方法选取2014年3月～2016年12月共26例在我院接受手术的累及C_2水平的多节段脊髓型颈椎病患者,均采用保留C_2棘突止点的潜行减压+全椎板切除减压侧块螺钉固定术治疗。观察患者神经功能恢复、颈椎曲度改变、轴性症状及C_5神经根麻痹发生情况。结果所有患者均顺利接受手术,手术时间(141.7±36.2)min,术中出血量(328.1±43.9)mL;椎板切除宽度(17.1±2.2)mm,JOA评分由术前的(7.4±2.3)分恢复为术后3个月时的(12.3±3.1)分及末次随访时的(13.5±3.3)分,不同时间点比较具有统计学意义(<0.05),末次随访时神经功能改善率达到(63.7±12.5)%。颈椎曲度指数由术前的(13.6±3.7)%,增加到术后3个月时的(16.8±4.3)%及末次随访时为(16.2±4.2)%,手术前后比较具有显著统计学差异(<0.05)。术后出现C_5神经根麻痹患者2例,发生率为7.7%(2/26)。根据轴性症状评定标准:优14例,良8例,可2例,差2例,AS发生率15.4%。结论保留C_2棘突止点全椎板减压侧块螺钉固定术是治疗累及C_2水平脊髓型颈椎病的一种有效术式,能够解除脊髓压迫并促进神经功能显著恢复,侧块螺钉植入可避免颈椎后凸畸形,同时可降低轴性症状及C_5神经根麻痹的发生。Objective To observe the effect of laminectomy with lateral mass screw fixation and preserve C2 spinous process for the treatment of cervical spondylotic myelopathy involving C2 segment. Methods From Mar 2014 to Dec 2016, 26 cases of cervical spondylotic myelopathy(CSM) patients involving C2 segment accepted the procedure of laminectomy with lateral mass screw fixation and preserve C2 spinous process. The postoperative neurological recovery, cervical curvature index(CCI), axial symptoms and C5 palsy were recorded and analyzed. Results The mean operative time was(141.7±36.2) min with a blood loss of(328.1±43.9) m L and the laminectomy width was(17.1±2.2) mm. The JOA score was improved form(7.4±2.3)preoperatively to(12.3±3.1)three months after surgery, and(13.5±3.3) at the final follow up( <0.05). The cervical curvature index was increased from(13.6±3.7) % preoperatively to(16.8±4.3)% three months after surgery, and(16.2±4.2) % at the last follow-up( <0.05). There were 2 patients with C5 palsy after operation, and the incidence was 7.7%(2/26). There were 3 patients occurred axial symptoms(15.4%). Conclusion As a surgical procedure, laminectomy with lateral mass screw fixation and preserve C2 spinous process is effectively for cervical spondylotic myelopathy involving C2 segment, which not only could maintain the cervical stability well, but also reduce the occurrence of axial symptom and C5 palsy.

关 键 词：脊髓型颈椎病 全椎板减压术 C2棘突 轴性症状 

分 类 号：R681.5[医药卫生—骨科学]