Centerpiece钛板内固定在单开门颈椎管扩大成形术中的应用

目的:探讨Centerpiece钛板内固定在单开门颈椎管扩大成形术的临床应用。方法:自2009年1月至2010年12月采用单开门颈椎管扩大成形Centerpiece内固定术治疗颈椎管狭窄症患者25例,男16例,女9例;年龄44～75岁,平均(57.2±6.7)岁。其中多节段脊髓型颈椎病8例,颈椎后纵韧带骨化症12例,发育性颈椎管狭窄症5例。以JOA评分(17分法)及其改善率评价术后神经功能改善情况;术后复查颈椎X线、CT,在术前及术后6个月的颈椎侧位X线片上测量C5节段椎管矢状径,计算椎管扩大率,评价椎管扩大和维持情况及门轴侧骨融合情况。结果:手术时间为(165.5±35.6)min;术中出血量为(325.0±75.1)ml。随访时间6～18个月,平均(7.3±3.8)个月。术前JOA评分为9.3±1.1;术后6个月为14.7±2.1(t=4.12,P<0.05),JOA改善率为(64.5±10.2)%。术后随访X线片及CT示椎管扩大满意,门轴侧均骨性愈合,均未见椎板塌陷和再关门现象,术前C5节段椎管矢状径为(9.0±1.5)mm,术后6个月为(14.3±2.0)mm(t=7.61,P<0.05),椎管扩大率为(67.6±11.8)%。结论:Centerpiece钛板内固定应用在单开门颈椎管扩大成形术中是安全有效的,在抬起椎板获得即刻稳定的同时,可以恢复椎管的完整性。

Clinical application of Centerpiece titanium plate fixation in open door laminoplasty

Objective: To explore the clinical application of Centerpiece titanium plate fixation in open door laminoplasty. Methods: From January 2009 to December 2010,25 patients with cervical spinal stenosis were treated by open door laminoplasty with Centerpiece titanium plate fixation. There were 16 males and 9 females,with a mean age of (57.2±6.7) years (ranged,44 to75 years). There were multilevel cervical myelopathy in 8 cases,posterior longitudinal ligament ossification in 12 cases and congenital cervical spinal stenosis in 5 cases. According to Japanese Orthopedic Association (JOA) score to evaluate nerve function and calculate improvement rate. X-ray and CT were used to evaluate postoperative spinal canal enlargement and bone fusion at the hinge side. The sagittal diameter of C₅ spinal canal on the lateral X-ray was measured before operation and 6 months after operation respectively,and the expansion rate of spinal canal was calculated(postoperative sagittal diameter-preoperative sagittal diameter)/(preoperative sagittal diameter)×100%]. Results: The operative time and intraoperative blood loss were respectively (165.5±35.6) min and (325.0±75.1) ml. All patients were followed up from 6 to 18 months with an average of (7.3±3.8) months. The JOA score increased from 9.3±1.1 before operation to 14.7±2.1 at 6 months after operation(t=4.12,P < 0.05),and the improvement rate was (64.5±10.2)%. Radiographic data showed spinal canal enlarged perfectly,bone fusion at hinge side and no cervical spinal stenosis was found. The sagittal diameter of C₅ spinal canal improved from (9.0±1.5) mm before operation to (14.3±2.0) mm at 6 months after operation(t=7.61,P < 0.05),and the expansion rate was (67.6±11.8)%. Conclusion: Clinical application of Centerpiece titanium plate fixation in open door laminoplasty is safe and effective. While vertebral plate is elevated to obtain instantly stability,at the same time,the integrity of spinal canal is also recovered.