叠瓦状重建联合钛板固定治疗单开门椎管成形术中门轴骨折伴椎板移位的疗效分析  

Analysis on the curative effect of imbricate reconstruction combined with titanium plate fixation in treating hinge fracture with laminae displacement in single-door laminoplasty

作　　者：李彦飞[1] 霍喜卫[1] 胡成栋[1] 李东风[1] 王飞[1] 李海涛[1] LI Yan-fei;HUO Xi-wei;HU Cheng-dong(Orthopedics Department,Handan Central Hospital,Handan 056001,China.)

机构地区：[1]邯郸市中心医院骨科,河北邯郸056001

出　　处：《中国医学装备》2021年第6期91-94,共4页China Medical Equipment

基　　金：河北省医学科学研究重点课题计划(20171132)“颈后路单开门微型钛板固定位置对脊髓型颈椎病患者神经功能恢复及轴性症状的影响”。

摘　　要：目的:观察叠瓦状重建联合微型钛板固定对单开门椎管成形术中椎板门轴骨折伴移位的稳定作用及效果分析。方法:选取在医院接受单开门椎管成形术治疗的283例脊髓型颈椎病患者,将术中发生门轴骨折伴椎板移位的28例患者纳入本研究,均采用椎板叠瓦状重建联合钛板支撑固定治疗,记录门轴断裂所在椎板的分布情况,观察术后患者神经功能(JOA)评分、颈椎曲度指数(CCI)、门轴融合率及轴性症状的发生情况。结果:28例患者术中单节段门轴骨折伴移位21例,两节段门轴骨折者7例,其分布部位为第3颈椎(C_(3))3节,第4颈椎(C_(4))10节,第5颈椎(C_(5))15节,第6颈椎(C_(6))6节,第7颈椎(C_(7))1节。JOA评分术前为(7.8±1.7)分,术后3个月时为(12.5±2.3)分,末次随访时为(13.4±2.6)分,差异有统计学意义(F=50.846,P<0.05);术前CCI为(17.1±3.8)%,术后3个月时为(15.2±3.1)%,末次随访时为(16.7±3.5)%,手术前后比较差异无统计学意义。术后有14.3%(4/28)的患者出现轴性症状;术后3个月及6个月时的门轴融合率分别达到82.9%(29/35)和94.3%(33/35);术后随访(18.7±4.1)个月,期内未见开门再关闭、椎板塌陷、钛板断裂及螺钉松动等情况发生。结论:颈后路单开门椎管成形术中门轴骨折较为常见,且最易发生在C5节段;叠瓦状重建联合钛板固定可有效促进椎板的融合,从而保证脊髓减压效果及颈椎的稳定性。Objective:To observe the stabilization and effect of imbricate reconstruction combined with mini type titanium plate fixation on laminae hinge fracture with laminae displacement in single-door laminoplasty.Methods:283 patients with cervical spondylotic myelopathy who underwent single-door laminoplasty in hospital were selected.Twenty-eight patients who occurred hinge fracture with laminae displacement during the surgery were included this research.All of them underwent the fixation treatment of imbricate reconstruction combined with the prop of titanium plate.And the distribution of the laminae with hinge breakage was recorded.And then,the neurological function score of Japanese Orthopaedic Association(JOA),cervical curvature index(CCI),the hinge fusion rate and the occurrence of axial symptoms of postoperative patients were observed.Results:In 28 patients,21 cases were intraoperative singlesegment hinge fracture with laminae displacement and 7 cases were two-segment hinge fractures.The distribution sites were:3 segments were in third cervical vertebra(C_(3)),10 segments were in 4th cervical vertebra(C_(4)),15 segments were in 5th cervical vertebra(C_(5)),6 segments were in 6th cervical vertebra(C6)and 1 segment was in 7th cervical vertebra.The JOA score increased from preoperative(7.8±1.7)scores to(12.5±2.3)scores at 3th month after surgery and(13.4±2.6)scores at the final follow-up,and the difference of JOA score among three stages was significant(F=50.846,P<0.05).The CCI was(17.1±3.8)%before surgery,and it was(15.2±3.1)%at 3th month after surgery,and it was(16.7±3.5)%at the final follow-up,and there was no statistically significant difference between pre-and postoperative level.After the surgery,14.3%(4/28)of the patients occurred axial symptoms.The hinge fusion rate was 82.9%(29/35)and 94.3%(33/35)at 3th and 6th month after surgery,respectively.During the postoperative followup period of(18.7±4.1)months,there were no occurrences of re-closed lamina,collapse of vertebral plate,fracture of titanium plate

关 键 词：脊髓型颈椎病 单开门椎管成形术 钛板 颈椎曲度 轴性症状 

分 类 号：R683.2[医药卫生—骨科学]