两种门轴咬骨钳在双开门椎管扩大成形中开门角度及颈椎功能的比较  

Comparison of the opening angle and cervical vertebra function of two different hinge rongeurs in French-door laminoplasty

作　　者：孙俊[1] 詹铭斌 刘希哲[2] 刘少喻[1,2,3] Sun Jun;Zhan Mingbin;Liu Xizhe;Liu Shaoyu(Department of Orthopedics,Seventh Affiliated Hospital of Sun Yat-sen University,Shenzhen 518000,Guangdong Province,China;Department of Spine Surgery,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,Guangdong Province,China;Orthopedics Institute,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,Guangdong Province,China)

机构地区：[1]中山大学附属第七医院骨科,广东省深圳市518000 [2]中山大学附属第一医院脊柱外科,广东省广州市510080 [3]中山大学附属第一医院骨科研究所,广东省广州市510080

出　　处：《中国组织工程研究》2023年第27期4337-4344,共8页Chinese Journal of Tissue Engineering Research

基　　金：深圳市医疗卫生三名工程项目(SZSM201911002),项目负责人:刘少喻;中山大学临床医学研究5010计划项目(2019009),项目负责人:刘少喻。

摘　　要：背景:双开门椎管扩大成形是治疗颈椎多节段退行性脊髓病的常用术式,目前对于术中开门角度的预测和控制尚待进一步改进。目的:比较颈后路双开门椎管扩大成形术中两种不同角度门轴咬骨钳制作门轴时的开门角度与疗效。方法:回顾性分析2018年6月至2020年6月中山大学附属第七医院和中山大学附属第一医院收治的颈椎多节段退行性脊髓病患者的资料,共纳入57例,其中31例使用20°门轴咬骨钳,26例使用15°门轴咬骨钳。从功能性指标(改良日本骨科协会评分、目测类比评分)、影像学指标(椎板角度、椎管矢状径、门轴愈合情况)、术后并发症(轴性症状、C_(5)神经根麻痹)等方面对两组患者的术前、术后情况进行对比分析。结果与结论:①两组患者的术后改良日本骨科协会评分及术后目测类比评分差异无显著性意义;②两组患者的术后椎板角度均显著大于术前(P<0.01),且15°咬骨钳组的术后椎板角度(62.74±7.62)°显著小于20°咬骨钳组(68.55±8.71)°(P<0.01);15°咬骨钳组的术后椎管矢状径(13.52±2.16)mm显著小于20°咬骨钳组(15.39±2.85)mm(P<0.01);③术后4周时,15°咬骨钳组的门轴融合率要显著高于20°咬骨钳组(49%,35%,P<0.01);④两组患者术后并发症的发生率差异无显著性意义;⑤提示使用门轴咬骨钳时,可在术前对开门角度进行预测,并在术中准确控制术后椎板开门角度;相比于20°门轴咬骨钳,使用15°门轴咬骨钳制作门轴可将椎板角度扩大约25°,术后达到63°左右,避免椎板角度及椎管矢状径过大;15°门轴咬骨钳和20°门轴咬骨钳均可获得满意的减压效果,但15°门轴咬骨钳组的门轴愈合时间更短,有利于术后神经功能的恢复。BACKGROUND: French-door laminoplasty is a commonly used procedure for the treatment of cervical multi-segment degenerative myelopathy. At present, the prediction and control of the intraoperative opening angle need further improvement.OBJECTIVE: To compare the opening angle and clinical outcomes of two different hinge rongeurs in the cervical French-door laminoplasty.METHODS: Data of 57 cervical multi-segment degenerative myelopathy patients in Seventh Affiliated Hospital of Sun Yat-sen University and First Affiliated Hospital of Sun Yat-sen University from June 2018 to June 2020 were retrospectively analyzed. The patients were divided into 20° rongeur group(n=31) and 15°rongeur group(n=26). Comparative study was made to find out the differences in functional outcomes(modified Japanese Orthopaedic Association score and visual analogue scale score), radiological outcomes(lamina angle, sagitial diameter of spinal canal, and hinge healing), and postoperative complications(axial symptoms and C5 nerve root paralysis).RESULTS AND CONCLUSION:(1) There was no significant difference in postoperative modified Japanese Orthopaedic Association score and postoperative visual analogue scale score between the two groups.(2) The postoperative lamina angles of the two groups were significantly higher than the preoperative lamina angles(P < 0.01). Among them, the postoperative lamina angle of the 15° hinge group(62.74±7.62)° was significantly smaller than that of the 20°hinge group(68.55±8.71)°(P < 0.01). The sagitial diameter of spinal canal of 15° rongeur group(13.52±2.16) mm was significantly lower than that of the 20°rongeur group(15.39±2.85) mm(P < 0.01).(3) At 4 weeks a?ter operation, the fusion rate of the hinge in the 15° rongeur group was significantly higher than that of the 20° rongeur group(49%, 35%, P < 0.01).(4) There was no significant difference in the incidence of postoperative complications between the two groups.(5) It is indicated that when the hinge rongeur is used, the opening angle can be predi

关 键 词：颈椎椎管扩大成形术 双开门 门轴咬骨钳 开门角度 椎板角度 门轴愈合 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R608