单开门术中门轴断裂伴椎板移位的处理方式及疗效对比  

Comparative of Different Treatment Methods for Hinge Fracture with Laminae Displacement in Open Door Laminoplasty

作　　者：田金辉 李志远 江仲超[1] 颜珍珍 李少伟 李晓东[1] 苗洁[1] TIAN Jin-hui;LI Zhi-yuan;JIANG Zhong-chao;YAN Zhen-zhen;LI Shao-wei;LI Xiao-dong;MIAO Jie(Department of Orthopedics, Handan Central Hospital, Handan 056001,China;Department of Orthopedics, Luquan People's Hospital of Shijiazhuang, Shijiazhuang 050200,China)

机构地区：[1]邯郸市中心医院骨科,邯郸056001 [2]石家庄市鹿泉人民医院骨科,石家庄050200

出　　处：《科学技术与工程》2022年第18期7810-7815,共6页Science Technology and Engineering

基　　金：河北省医学科学研究重点课题(20191830)。

摘　　要：针对单开门椎管扩大成形术中椎板门轴侧断裂伴移位的问题,对不同门轴处理方式的术后疗效进行研究。通过回顾性分析,将2013年5月—2018年9月在邯郸市中心医院接受单开门椎管成形钛板固定术治疗的319例脊髓型颈椎病患者纳入研究中,其中有63例患者术中发生门轴断裂伴椎板移位,根据处理方式将其分为两组:重建组(35例),对椎板进行叠瓦状重建及钛板固定治疗;切除组(28例),将断裂并移位的椎板切除。记录并比较两组患者术中的相关指标,观察患者神经功能(JOA评分)、颈椎曲度指数(cervical curvature index,CCI)、颈后肌群横截面积变化及轴性症状的发生情况。结果表明:在手术时间及术出血量上,两组比较无显著统计学差异(P>0.05)。术后两组的颈后肌群横截面积较术前均有明显减小(P<0.05),但重建组横截面积减小程度明显低于切除组(P<0.05)。重建组术后CCI获得较好维持(P>0.05),切除组的CCI较术前出现明显丢失(P<0.05);至末次随访时,组间比较有显著统计学差异(P<0.05)。两组患者JOA评分均有显著升高(P<0.05),组间比较无显著统计学差异(P>0.05)。术后重建组有8.6%的患者出现轴性症状(3/35),切除组为21.3%(6/28),具有显著统计学差异(P<0.05)。术后3个月时,重建组81.6%(31/38)的断裂门轴获得骨性融合,至术后6个月时,有94.7%(36/38)的断裂门轴获得骨性融合。可见,对于门轴断裂伴椎板移位的患者,采用叠瓦状椎板重建联合钛板固定及切除椎板均不会影响术后神经功能的恢复,但椎板重建更有利于颈椎曲度的维持并减轻颈后肌群的萎缩,从而降低轴性症状的发生。In order to solve the problem of hinge fracture with laminae displacement during open door laminoplasty,several treatment methods were investigate for the postoperative clinical efficacy.A total of 319 patients with cervical spondylotic myelopathy accepted open-door laminoplasty and titanium plate fixation in Handan central hospital from May 2013 to September 2018 were retrospective analyzed,among of them,63 patients occurred hinge fracture with laminae displacement.Patients were divided into two groups according to the treatment methods.Reconstruction group(35 cases)accepted imbricate reconstruction combined with titanium plate fixation,and resection group(28 cases)accepted lamina resection.The intraoperative indicators were recorded and compared.The neurological function(JOA score),cervical curvature index(CCI),cross sectional area of posterior cervical muscles and axial symptoms were observed.The results show that there was no significant difference in terms of operative time and bleeding volume between the two groups(P>0.05).The cross-sectional area of the posterior cervical muscles in both groups was significantly reduced compared with the preoperative level(P<0.05),but the decline degree in reconstruction group was significantly lower than that in the resection group(P<0.05).The CCI in the reconstruction group was maintained well after surgery(P>0.05),but in resection group,it was significantly lost(P<0.05).The JOA scores in both groups was significantly increased after surgery(P<0.05),and there was no significant difference between the groups at different time point(P>0.05).The occurrence of axial symptoms was 8.6%(3/35)in reconstruction group and 21.3%(6/28)in resection group(P<0.05).The hinge fusion rate at 3 and 6 months after surgery was 81.6%(31/38)and 94.7%(36/38),respectively.It is concluded that,for patients with hinge fracture and laminar displacement,imbricate reconstruction combined with titanium plate fixation will not affect the recovery of neurological function,but hinge reconstruction is mor

关 键 词：单开门椎管成形术 脊髓型颈椎病 钛板 颈椎曲度 轴性症状 

分 类 号：R681.5[医药卫生—骨科学]