颈椎椎弓根钉固定结合单开门椎管扩大成形治疗颈椎管狭窄伴无骨折脱位型颈脊髓损伤的临床研究

目的探讨颈椎椎弓根钉固定结合单开门椎管扩大成形治疗颈脊髓前方无局限性压迫、颈椎不稳定的颈椎管狭窄伴无骨折脱位型颈脊髓损伤的临床疗效。方法自2006-06--2011-03纳入颈椎管狭窄伴无骨折脱位型颈脊髓损伤44例。包括脊髓中央综合征26例，前脊髓损伤综合征12例，Brown-Sequard综合征4例，其他2例。结果所有患者均顺利完成手术。获12—60个月随访40例，平均（25．2±17．6）个月，末次随访时JOA脊髓功能评分改善率为68．5％；但双上肢功能恢复较差，出现双手不同程度肌肉萎缩5例；X线片检查显示颈椎生理曲度良好，无断钉、断棒及颈椎失稳；CT检查显示螺钉位置良好，椎管扩大成形满意，无门轴断裂及再关门。结论颈椎椎弓根钉固定结合单开门椎管扩大成形治疗颈脊髓前方无局限性压迫、颈椎不稳定的颈椎管狭窄伴无骨折脱位型颈脊髓损伤可取得较满意疗效。

Posterior pedicle screw fixation and expansive open-door laminoplasty for cervical spinal cord injury with spondylostenosis and without radiological abnormality

Objective To investigate the clinical efficacy of posterior pedicle screw fixation and C3-7 expansive open--door laminoplasty for cervical spinal cord injury without fracture and dislocation in patients with cervical stenosis. Methods Between June 2006 and March 2011, 44 patients with cervical spinal cord injury with cervical stenosis, but without fracture or dislocation in plain irdms were included to receive posterior pedicle screw fixation and C3-7 expansive open-door laminoplasty. The spinal cord in all patients was incompletely injured with central cord syndrome in 26 patients, anterior spinal cord syndrome in 12, Brown-Sequard syndrome in 4 and another in 2. Results All patients were successfully managed with this technique. The 40 patients were followed up for an average of （25.2±17.8） months （range 12 to 60 months）. But for 5 patients who still sustained a poor functional improvement of upper extremities, the JOA improvement rate was 68.5% at last follow- up. Postoperative radiography demonstrated that cervical alignment was maintained in all patients and no implant failure and spinal instability developed. CT scan showed screws were in place and the patency of spinal canal was maintained. No re- closure of the canal and fracture of hinge occurred during foLlow-up. Conclusion posterior pedicle screw fixation and C3-7 expansive open-door laminoplasty is an effective procedure for cervical spinal cord injury without frac＇ture and dislocation in patients with cervical stenosis.