颈后路单开门椎管成形术中门轴断裂相关原因分析及对临床疗效的影响  

An Analysis of Causes of Hinge Fracture During Laminoplasty and Its Effect on Clinical Efficacy

作　　者：霍喜卫[1] 李东风[1] 胡成栋[1] 李彦飞[1] 王飞[1] 王瑞[1] HUO Xiwei;LI Dongfeng;HU Chengdong(Handan Central Hospital,Hebei Handan 056001,China)

机构地区：[1]河北省邯郸市中心医院,河北邯郸056001

出　　处：《河北医学》2020年第12期2044-2047,共4页Hebei Medicine

基　　金：河北省医学科学研究重点课题计划项目,(编号:20171132)。

摘　　要：目的:探讨颈后路单开门术中导致门轴断裂的相关原因及对临床疗效产生的影响。方法:选取2014年5月至2018年10月在我院接受单开门椎管成术治疗的214例脊髓型颈椎病患者,根据门轴是否发生断裂将患者分为断裂组(58例)和完整组(156例)。观察并比较两组患者的神经功能(JOA评分)恢复、颈椎曲度(CCI)改变、轴性症状严重程度及与门轴断裂相关的因素。结果:两组在开门位置上比较无显著统计学差异(P>0.05);断裂组的椎板开门角度显著大于完整组,而骨密度则显著低于完整组(P<0.05)。术后两组患者JOA评分均有显著升高(P<0.05),神经功能恢复率组间比较无统计学差异(P>0.05);两组患者的CCI均获得较好维持(P>0.05),组间比较差异无统计学意义(P>0.05)。术后VAS评分均较术前有显著升高(P<0.05),且断裂组的分值明显高于完整组(P<0.05)。结论:门轴断裂与骨密度减低和开门角度过大有关,门轴断裂会导致轴性症状加重,但不会影响神经功能的恢复及颈椎曲度的维持。Objective:To observe the causes of hinge fracture during laminoplasty and its effect on clinical efficacy.Methods:A total of 214 patients with cervical spondylotic myelopathy who underwent laminoplasty in our hospital from May 2014 to October 2018 were enrolled,and they were divided into fracture group(58 cases)and intact group(156 cases)according to whether the hinge was fractured.The neurological function(JOA score),cervical curvature index(CCI),axial symptoms(VAS score)and factors associated with hinge fracture were observed and compared.Results:There was no significant difference in the hinge position between the 2 groups(P>0.05).The laminae opening angle of the fractured group were significantly greater than that of the intact group,while the bone mineral density was significantly lower than that of the intact group(P<0.05).The postoperative JOA score was significantly increased in both groups(P<0.05),and there was no statistical difference in neurological function recovery rate between the 2 groups(P>0.05).The CCI was well maintained in both groups(P>0.05),and there was no significant difference between groups(P>0.05).The VAS scores of the two groups showed a significant increase when compared with the preoperative level(P<0.05),and the scores in fractured group was higher than the intact group at different time points(P<0.05).Conclusions:The hinge fracture is associated with the decrease of bone mineral density and excessive opening angle.It will aggravate the axial symptoms,but will not affect the recovery of neurological function and the maintenance of cervical curvature.

关 键 词：脊髓型颈椎病 单开门椎管成形术 门轴断裂 颈椎曲度 轴性症状 

分 类 号：R687.3[医药卫生—骨科学]