双Y型钛板内固定联合后方韧带复合体回植椎板成形术在脊髓脊柱手术的临床应用  

Clinical application of laminoplasty in spinal cord and spine surgery with double Y-shaped titanium plate internal fixation combined with posterior ligament complex replantation

作　　者：荣孝慈 肖宗宇 黄煜伦 李学涛 邵杰 祝海平 王之敏 Rong Xiaoci;Xiao Zongyu;Huang Yuun;Li Xuetao;Shao Jie;Zhu Haiping;Wang Zhimin(Department of Neurosurgery,The Fourth Affiliated Hospital of Soochow University/Suzhou Dushu Lake Hospital,Suzhou,Jiangsu 215000)

机构地区：[1]苏州大学附属第四医院苏州市独墅湖医院神经外科,江苏苏州215000

出　　处：《中国微侵袭神经外科杂志》2023年第12期140-145,共6页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：国家自然科学基金(编号:82173279、82102770)。

摘　　要：目的探讨双Y型钛板内固定联合后方韧带复合体(posterior ligamentous complex,PLC)回植椎板成形术在脊髓脊柱手术的应用效果。方法回顾性分析在脊髓脊柱手术中采用经双Y型钛板内固定联合PLC回植技术重建椎管的6例脊髓脊柱疾病病例资料。术后所有患者随访3~12个月,复查时行脊柱螺旋CT三维重建及脊柱MRI检查。采用改良McCormick分级标准评估临床症状和日本骨科协会脊髓功能评分(IJOA评分)评估神经功能,末次随访时分级及评分分别与术前比较,采用White&Panjabi脊柱不稳评分标准评估术后脊柱稳定性,分别测量手术前后颈、胸、腰椎使用双Y型钛板PLC回植的各节段椎管的横径和前后径,评估术后是否造成椎管狭窄。结果6例患者术中游离椎板节段数为(4.0±2.9)个(1~8个),手术椎管共24个节段,其中固定节段23个,包括使用双Y型微钛板固定节段为15段,两孔微钛板固定节段为8段。除1例术后切口为Ⅰ类乙等愈合,其余患者术后切口均为Ⅰ类甲等愈合,无感染、局部异常积液、脑脊液漏,未出现钛板置入导致的脊髓、神经根损伤等并发症。术后复查CT显示局部微钛板固定良好,无塌陷、移位、断板等情况发生,椎管无后凸、侧凸畸形。6例患者随访时间为(8±4.1)个月(3~12个月)。McCormick分级,术前:Ⅱ级5例,Ⅲ级1例;末次随访:Ⅰ级3例,Ⅱ级1例,Ⅲ级1例,Ⅳ级1例;与术前相比,临床症状好转3例,不变1例,恶化2例。IJOA评分术前(16.33±1.97)分,末次随访升至(17.67±2.58)分,差异有统计学意义(t=-4,P=0.01)。末次随访时,6例患者术后White&Panjabi脊柱不稳评分均<5分,无1例出现脊柱失稳。与术前比较15个使用双Y型微钛板固定节段术后椎管横径和前后径,差异均无统计学意义(均P>0.05)。结论脊髓脊柱手术采用双Y型钛板内固定联合PLC回植椎板技术重建椎管的患者,术后神经功能改善、并发症少,术后无脊柱失稳及椎�Objective To explore the application of laminoplasty with double Y-shaped internal fixation titanium plate internal fixation combined with posterior ligament complex(PLC)replantation in spinal cord surgery.Methods A retrospective analysis was conducted on the clinical data of 6 patients with spinal cord diseases who underwent spinal cord surgery.These patients were underwent surgery using the technology of double Y-shaped titanium plate internal fixation combined with PLC replantation to reconstruct the spinal canal.All patients were followed up for 3-12 months after surgery,and spinal spiral CT three-dimensional reconstruction and spinal MRI examination were performed after surgery.Clinical symptoms were assessed using the modified McCormick grading standard,and neurological function was evaluated by Japanese Orthopedic Association Spinal Cord Function Score(IJOA score).The grading and scoring at the last follow-up were compared with those before surgery.The White&Panjabi spinal instability scoring standard was used to evaluate the stability of the spine after surgery.The transverse and anteroposterior diameters of each segment of the spinal canal with double Y-shaped titanium plate internal fixation combined with PLC replantation were measured before and after surgery to evaluate whether there was spinal stenosis after surgery.Results In 6 cases,there were 1-8 segments of free lamina,with an average of 4.0±2.9 segments.A total of 24 spinal canal segments were operated on.Among them,23 spinal canal segments were fixed,including 15 segments were fixed using double Y-shaped micro titanium plates,and 8 segments were fixed using two hole micro titanium plates.Except for 1 case had Class I Grade B incision healing,all other patients had a Class I Class A incision healing without infection,no local fluid accumulation,cerebrospinal fluid leakage,and no other complications such as spinal cord or nerve root injury caused by the technique were recorded.Postoperative CT scan showed good fixation of the micro titanium plat

关 键 词：椎管狭窄 椎板成形术 双Y型钛板 后方韧带复合体 脊柱稳定性 

分 类 号：R744[医药卫生—神经病学与精神病学]