颈后路单开门椎管扩大成形跳跃式与连续式微型钛板内固定术治疗多节段脊髓型颈椎病的对比研究  

Unilateral open-door laminoplasty through cervical posterior approach combined with intermittent internal fixation versus continuous internal fixation with miniature titanium plates for treatment of multiple-segment cervical spondylotic myelopathy:a compar

作　　者：何少奇[1] 汤呈宣[1] 唐小君[1] 戴鸣海[1] HE Shaoqi;TANG Chengxuan;TANG Xiaojun;DAI Minghai(The People’s Hospital of Ruian City,Ruian 325200,Zhejiang,China)

机构地区：[1]瑞安市人民医院,浙江瑞安325200

出　　处：《中医正骨》2019年第4期8-16,21,共10页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：瑞安市2017年科技创新专项项目(MS2017008)

摘　　要：目的:比较颈后路单开门椎管扩大成形跳跃式与连续式微型钛板内固定术治疗多节段脊髓型颈椎病的临床疗效及安全性。方法:回顾性分析120例多节段脊髓型颈椎病患者的病例资料,其中采用颈后路单开门椎管扩大成形跳跃式微型钛板内固定治疗60例(跳跃式固定组),C_3、C_5、C_7开门侧予以Arch钛板固定,C_4、C_6开门侧予以传统缝线固定;采用颈后路单开门椎管扩大成形连续式微型钛板内固定60例(连续式固定组),C_3～C_7开门侧均予以Arch钛板固定。同时按照内固定方式不同将600节椎板固定节段分为钛板固定节段和缝线固定节段。比较2组患者的手术时间、术中出血量、住院费用、住院时间、日本骨科协会(Japanese orthopaedic association,JOA)脊髓型颈椎病评分(17分法)、颈椎功能障碍指数(the neck disability index,NDI)评分、JOA改善率、颈椎曲度指数、颈椎活动度、脊髓后移距离以及并发症发生情况。比较钛板固定节段和缝线固定节段的椎管矢状径、Pavlov比值、椎板开门角度。结果:①一般指标。跳跃式固定组住院费用少于连续式固定组[(5.56±0.29)万元,(7.76±0.37)万元,t=-36.383,P=0.000];2组患者术中出血量、手术时间及住院时间比较,差异均无统计学意义[(305.50±59.99)mL,(292.50±52.35)mL,t=1.265,P=0.208;(132.33±16.79)min,(132.67±18.88)min,t=-0.102,P=0.919;(10.38±2.34)d,(10.42±2.36)d,t=-0.078,P=0.938]。②JOA脊髓型颈椎病评分。术前和术后1年,2组患者JOA脊髓型颈椎病评分比较,组间差异均无统计学意义[(9.58±1.37)分,(9.55±1.53)分,t=0.126,P=0.900;(14.52±1.52)分,(14.42±1.64)分,t=0.400,P=0.690];术后1年,2组患者JOA脊髓型颈椎病评分均高于术前(t=49.103,P=0.000;t=48.991,P=0.000)。③NDI评分。术前和术后1年,2组患者NDI评分比较,组间差异均无统计学意义[(27.40±10.10)分,(27.70±9.91)分,t=-0.164,P=0.870;(14.17±6.08)分,(14.43±5.38)分,t=-0.255,P=0.799];术�Objective:To compare the clinical curative effects and safety of unilateral open-door laminoplasty through cervical posterior approach and intermittent internal fixation with miniature titanium plates versus unilateral open-door laminoplasty through cervical posterior approach and continuous internal fixation with miniature titanium plates for treatment of multiple-segment cervical spondylotic myelopathy(CSM).Methods:The medical records of 120 patients with multiple-segment CSM were analyzed retrospectively.Sixty patients were treated with unilateral open-door laminoplasty through cervical posterior approach and intermittent internal fixation with miniature titanium plates(intermittent fixation group),and the vertebral plate of C 3,C 5 and C 7 at door-opening side were fixed with Arch titanium plates,and the vertebral plates of C 4 and C 6 were fixed with traditional suture.The other sixty patients were treated with unilateral open-door laminoplasty through cervical posterior approach and continuous internal fixation with miniature titanium plates(continuous fixation group),and the vertebral plates of C 3-C 7 at door-opening side were fixed with Arch titanium plates.The 600 segments of fixed vertebral plates were divided into titanium plate fixation segments and suture fixation segments according to the internal fixation methods.The operative time,intraoperative blood loss,cost of hospitalization,hospital stay,Japanese Orthopedic Association(JOA)CSM scores,the neck disability index(NDI),JOA improvement rate,cervical curvature index(CCI),range of motion(ROM)of cervical vertebrae,post-displacement distance of the spinal cord and complications were compared between the 2 groups.The sagittal diameter of vertebral canal,Pavlov ratio and the opening angle of vertebral plate were compared between titanium plate fixation segments and suture fixation segments.Results:The total cost of hospitalization was less in intermittent fixation group compared to continuous fixation group(55.6+/-2.9 vs 77.6+/-3.7 thousands Yuan, t=-3

关 键 词：颈椎病 椎管 椎管成形术 钛板 跳跃式固定 连续式固定 临床试验 

分 类 号：R687.3[医药卫生—骨科学]