微型钛钉-钛板固定行颈椎管扩大成形术的初步临床报告

目的：探讨微型螺钉-钛板固定行颈椎管扩大成形术的可行性,报告其临床应用的初步效果.方法：利用微型钛钉-钛板固定方法行颈椎后路单开门手术治疗颈椎病22例,手术减压节段包括C3～C7 5个节段20例,C2～C7 6个节段2例,手术方式均采用单开门,椎板抬起（开门）后,剪取合适大小及形状的钛板,利用微型钛钉将其分别固定在抬起的椎板及侧块上.结果：术中及术后均未见因钛板及钛钉置入引起的脊髓、神经根及血管损伤.随访3～18个月,手术后3个月时JOA评分从术前的9.3分提高到13.5分.随访期间未见钛板及钛钉脱落移位;14例患者术后行CT检查,未见椎板塌陷或再关门现象,门轴侧椎板切除及骨折处骨质再生融合13例,1例术后3个月时尚未完全融合,但骨质已经开始生长.结论：在颈椎管扩大成形手术中,利用微型钛钉-钛板固定是一种简单、可靠、安全、有效的方法,在抬起的椎板获得即刻稳定的同时,可以恢复椎管的完整性.

Preliminary clinical report of cervical laminoplasty using miniscrew-plates fixation

Objective:To study the feasibility of cervical laminoplasty using miniscrew-plates fixation,and to report the preliminary results of its clinical application.Method:Posterior unilateral open-door laminoplasty using miniscrew-plates fixation was performed on 22 patients of cervical spondylopathy.Operative decompression included 5 levels from C3 to C7 in 20 cases,6 levels from C2 to C7 in 2 cases.Unilateral open-door technique was used in all the patients,after the laminae were elevated (opened),a titanium miniplate was cut and modified into a suitable size and shape,and was fixed to the elevated laminae and lateral masses using miniscrews.Result:There was no injury of spinal cord,nerve roots or vertebral artery due to the miniscrew-plates insertion during and after the operation.Follow-up ranged 3~18 months,JOA score increased from preoperative 9.3 to 13.5 in 3 months after the operation.In the period of follow-up,there was no screw loosening or displacement;postoperative CT was performed on 14 cases,in which,there was no laminae subsidence or reclose of the opened laminae;by the way,bone regrowth and fusion in the gutter of hinged side was shown in 13 cases;in one case,bone growth without complete fusion was shown in 3 months of follow up.Conclusion:Using miniscrew-paltes fixation for cervical laminoplasty is a simple,durable,safe and effective method;in the time of instant stability of the elevated laminae,the integrity of spinal canal is recovered.