单开门椎板成形联合单侧侧块螺钉治疗颈椎后纵韧带骨化合并颈椎不稳  

Expansive open-door laminoplasty combined with unilateral lateral mass screw in the treatment of ossification of posterior longitudinal ligament with cervical instability

作　　者：周洋[1] 李驰[1] 戴王颖 滕红林[1] 朱旻宇[1] 王宇[1] 王靖[1] ZHOU Yang;LI Chi;DAI Wang-ying;TENG Hong-lin;ZHU Min-yu;WANG Yu;WANG Jing(Department of Spine Surgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,Zhejiang,China)

机构地区：[1]温州医科大学附属第一医院脊柱外科,浙江温州325000

出　　处：《中国骨伤》2025年第2期170-175,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨颈椎单开门椎板成形(expansive open-door laminoplasty)联合单侧侧块螺钉对颈椎后纵韧带骨化合并颈椎不稳患者的疗效及矢状位平衡影响。方法:2012年5月至2018年7月采用颈后路手术治疗的颈椎后纵韧带骨化合并颈椎不稳患者65例,根据手术方法将患者分为两组。单开门椎板成形术组34例,男19例,女15例,年龄49~60(54.4±4.8)岁,病程8~39(21.0±8.2)个月。单开门椎板成形术联合单侧侧块螺钉固定术组31例(单开门联合侧块螺钉组),男17例,女14例,年龄50~59(55.4±3.2)岁,病程7~48(23.7±13.1)个月。比较两组手术时间、术中出血量、术后并发症。观察比较术前和末次随访时在X线片上测量矢状垂直角(sagittal vertical angle,SVA),C0-C2 Cobb角和C2-C7 Cobb角。使用日本矫形外科学会(Japanese Orthopedic Association,JOA)评分评估临床疗效。结果:所有患者手术顺利,单开门联合侧块螺钉组手术时间(109±15)min,长于单开门组(128±16)min,差异有统计学意义(P<0.05)。两组术中出血量、术后轴性症状、随访时间比较,差异均无统计学意义(P>0.05)。末次随访时,两组JOA评分中运动、感觉和总分较术前明显提升(P<0.05);膀胱功能评分无明显变化(P>0.05);而两组间比较差异均无统计学意义(P>0.05)。两组末次随访时C0-C2 Cobb角较术前均有增加,单开门组增加的幅度更大(P<0.05);两组C2-C7 Cobb角均有减少,单开门联合侧块螺钉组患者减少的幅度更大(P<0.05)。单开门组C2-C7 SVA在末次随访时有明显增加(P<0.05),单开门联合侧块螺钉组无明显变化(P>0.05)。结论:颈椎后路单开门椎板成形术联合单侧侧块螺钉内固定改善了颈椎后纵韧带骨化合并颈椎不稳患者的神经功能和生活质量,相比单开门椎板成形术,能改善术后颈椎后凸和前倾。Objective To investigate the effect of expansive open-door laminoplasty combined with single lateral mass screw fixation on the posterior longitudinal ligament ossification and cervical instability and its effect on sagittal balance.Methods A retrospective analysis of 65 patients with the posterior longitudinal ligament with cervical instability from May 2012 to July 2018 was conducted.The patients were divided into two groups according to the surgical method.Thirty-four patients were treated with open-door laminoplasty including 19 males and 15 females,aged 49 to 60 years old with an average age of(54.4±4.77)years old;symptoms lasted 8 to 39 months with an average of(21.0±8.2)months.Thirty-one patients were treated with single-door laminoplasty combined with single mass screw fixation including 17 males and 14 females,aged 50 to 59 years old with an average age of(55.4±3.2)years;symptoms lasted 7 to 48 months with an average of(23.7±13.1)months.General information of the two groups,including operation time,intraoperative blood loss,and postoperative complications was recorded.Sagittal vertical axis(SVA),C0-C2 and C2-C7 cobb angle were measured by X-ray before operation and at the last follow-up.Clinical efficacy was evaluated using the Japanese Orthopaedic Association(JOA)score.Results Surgery was successful in all patients.The operation time(109±15)min in the single-door laminoplasty combined with lateral mass screw fixation group was longer than that in the single-door group(128±16)min(P<0.05).There was no significant difference in intraoperative blood loss,postoperative axial symptoms and follow-up time between two groups(P>0.05).At the latest follow-up,both groups showed significant improvement in the motor and sensory components of the JOA score and the total JOA score compared to pre-surgery(P<0.05)and no significant change in bladder function score(P>0.05).There was no significant difference between two groups(P>0.05).At the latest follow-up,the C0-C2 Cobb angle increased in both groups compared to

关 键 词：后纵韧带骨化 单开门椎板成形术 侧块螺钉 矢状位平衡 

分 类 号：R681.5[医药卫生—骨科学]