颈椎单开门椎管成形微钛板与丝线或锚钉固定术后C5神经根麻痹的对比分析

 目的 比较颈椎单开门椎管扩大成形术中使用微钛板于开门侧固定椎板和使用丝线或锚钉于铰链侧固定椎板对C5神经根麻痹及再关门的影响。方法 回顾性分析2011年1月至2013年1月采用颈椎单开门椎管扩大成形术治疗142例脊髓型颈椎病患者资料，根据控制开门方式将患者分为铰链侧固定组(使用丝线或锚钉于铰链侧固定椎板)和开门侧固定组(使用微钛板于开门侧固定椎板)。铰链侧固定组78例，男46例，女32例；年龄42～68岁，平均59岁。开门侧固定组64例，男41例，女23例；年龄44～71岁，平均57岁。术后采用日本骨科协会(Japanese Orthopaedic Association, JOA)评分评定神经功能并计算改善率，记录手术时间、出血量及C5神经根麻痹情况，比较两组开门角度、颈椎曲度指数、脊髓后移及脊髓压迫程度等。结果 铰链侧固定组和开门侧固定组患者均获得随访，随访时间均超过12个月；两组患者均一期愈合。铰链侧固定组术后9例发生C5神经根麻痹，发生率为11.5%(9/78)；微钛板开门侧固定组1例发生C5神经根麻痹，发生率为1.6%(1/64)；两者比较差异有统计学意义(P=0.047)。铰链侧固定组开门角度及脊髓后移量大于微钛板开门侧固定组。10例C5神经根麻痹者的脊髓后移量为(3.97±1.19) mm，较无C5神经根麻痹者(2.57±1.01) mm]高。铰链侧固定组和开门侧固定组术前(12.23%±3.70%和11.38%±4.29%)及术后1周(12.12%±3.77%和11.31%±4.35%)颈椎曲度指数无差异；术后12个月JOA评分(12.35±1.09)分和(13.55±0.91)分]、JOA评分改善率(64.24%±9.49%和61.78%±11.48%)及脊髓受压程度(0.74%±0.71%和0.75%±0.67%)无差异。术后6个月CT示铰链侧固定组27%患者椎板开门角度丢失>10°，微钛板开门侧固定组开门角度无变化。结论 颈椎单开门椎管扩大成形术中使用微钛板固定与使用丝线或锚钉固定控制开门角度相比，不影响神经功能恢复，但可降低C5神经根麻痹的发生率及减少椎板开门角度丢失。

A control study of C5 palsy after expansive open-door laminoplasty with miniplate or suture/anchor fixation

Objective To evaluate and compare C5 palsy and closure of the opened lamina after expansive open-door Laminoplasty (EOLP) with miniplate or suture/anchor fixation. Methods Between January 2011 and January 2013, a total of 142 patients with cervical myelopathy who were treated by EOLP were divided into hinge-side fixation group (fixed with suture/anchor, 78 cases)and open-side fixation group (fixed with miniplate, 64 cases). The Japanese Orthopaedic Association (JOA) score was used for neurological assessment and recovery rate (RR) counting. Opening angles, cervical curvature index (CCI), posterior shifting of spinal cord (PSSC) and severity of cord compression were recorded and compared. Results All patients in both group were followed up for more than 12 months. All incisions healed by first intention. C5 palsy occurred in 9 patients (9/78, 11.5%) of hinge-side fixation group, and 1 patients (1/64, 1.6%) of open-side fixation group, showing significant difference (P=0.047). Opening angles and PSSC in hinge-side fixation group were greater than that in open-side fixation group. PSSC of 10 patients with C5 palsy were 3.97?1.19 mm, and greater than that of other patients without C5 palsy 2.57?1.01 mm. There was no significant difference in CCI before (12.23%?3.70%, 11.38%?4.29%) and 1 week (12.12%?3.77%, 11.31%?4.35%) after operation. No significant difference was found in JOA scores (12.35?1.09, 13.55?0.91), JOA improvement rate (64.24%?9.49%, 61.78%?11.48%) and cord compression (0.74?0.71, 0.75?0.67) at 12 months after operation. In 6 months postoperatively, 27% of patients in hinge-side fixation group, none in open-side fixation group were identified with 10% decrease or more in opening angles of lamina. Conclusion EOLP with miniplate fixation has the same clinical outcome as fixed with suture/anchor, but will reduce the incidence of C5 palsy and prevent further closure of the opened lamina.