微型钛板固定颈椎单开门椎管扩大成形术的临床应用

目的:评价微型钛板固定颈椎单开门椎管扩大成形术治疗脊髓型颈椎病的临床疗效。方法:2009年2月至2011年4月,采用单开门颈椎管扩大成形ARCH钛板内固定治疗脊髓型颈椎病,获得完整随访16例(A组),与2007年3月至2009年1月行颈椎单开门椎管成形术治疗的脊髓型颈椎病18例(B组)进行对比分析。分析内容包括手术时间、术中出血量、JOA(17分法)评分改善率、轴性症状的产生及颈椎曲度的变化。结果:手术时间、术中出血量、术后6个月JOA评分改善率A组分别为(122.0±26.8)min、(153.0±46.7)ml、(59.4±11.6)%,B组分别为(119.0±28.6)min、(151.0±50.4)ml、(58.7±12.7)%,两组比较均无统计学意义(P>0.05)。A组术后有明显轴性症状患者为3例(18.75%),B组为6例(33.33%),两组差异有统计学意义(P<0.01);A组术前颈曲角度(17.9±5.2)°与术后的(18.2±4.8)°比较,差异无统计学意义(P>0.05),B组术前颈曲角度(18.1±6.3)°与术后的(16.3±5.9)°比较,差异有统计学意义(P<0.05)。结论:微型钛板固定颈椎单开门椎管扩大成形术能减少术后轴性症状的发生和颈椎曲度的丢失,可提高脊髓型颈椎病的治疗效果。

Clinical application of titanium miniplate in cervical expansive open-door laminoplasty

Objective: To evaluate the clinical effects of titanium miniplate in cervical expansive open-door laminoplasty in treating cervical spondylosis. Methods: From February 2009 to April 2011,16 patients underwent expansive open-door laminoplasty by titanium miniplate fixation were classified as group A;18 patients with conventional unilaterally open-door laminoplasty from March 2007 to January 2009 were served as control(group B). The operative time,blood loss during the operations,JOA score of the 6 months after operation,the incidence of axial symptom,curvature of cervical vertebrae were compared respectively between the two groups. Results: Operative time,blood loss,improvement rate of JOA in group A were respectively(122.0±26.8) min,(153.0±46.7) ml,(59.4±11.6)%; and in group B were(119.0±28.6) min,(151.0±50.4) ml,(58.7±12.7)%. Those showed no significant difference between two groups(P>0.05). Three cases(18.75%)occurred obviously axial symptom in group A and six cases(33.33%) occurred in group B,there was significant difference in the incidence of axial symptom between two groups(P<0.01). Preoperative and postoperative curvature of cervical vertebrae in group A was (17.9±5.2)° and(18.2±4.8)°,without significant difference;in group B,postoperative curvature of cervical vertebrae decreased obviously than the preoperative(16.3±5.9)° vs(18.1±6.3)°](P<0.05). Conclusion: Both surgical protocols are effective on preventing reclose of opened laminae,moreover the modified laminoplasty is advanced on reducing the occurrence of axial symptoms and loss of cervical curvature.