微创松解疗法治疗指屈肌腱狭窄性腱鞘炎研究

目的:评价Centerpiece钢板在颈椎单开门术中应用价值及相对于传统丝线缝合固定方法的优缺点.方法:自2009年12月至201 1年8月,采用手术治疗脊髓型颈椎病32例,其中采用颈后路单开门椎板成形术加Centerpiece钢板内固定治疗15例(A组),男8例,女7例；年龄51～65岁,平均60.5岁；病程2～15个月.采用传统颈椎椎管单开门扩大成形术(丝线缝合固定)治疗17例(B组),男9例,女8例；年龄49～66岁,平均61.5岁；病程1～14个月.两组患者术前均存在不同程度的行走不稳症状,颈椎MRI上可见颈髓受压明显伴有脊髓变性.按日本矫形外科学会(JOA)评分法分别在术前和术后6个月对患者脊髓神经功能进行评分,测定患者术前及术后CT上椎管矢状径(AP)及颈椎活动度(ROM).结果:32例患者均获得随访,时间8～20个月,平均13个月.所有切口愈合良好,未出现内固定松动、断裂及脊髓损伤加重等并发症.术后症状均明显恢复,复查MRI、颈椎CT见椎管容积明显扩大,术后随访无再关门及钢板螺钉松动的异常情况. A组平均手术时间、出血量分别为(155±12.3) min、(407±11.8) ml；B组平均手术时间、出血量分别为(148±14.4) min、(398±15.4) ml,两组比较均无统计学意义(P＞0.05).JOA评分A组由术前的9.1±2.6提高到术后的15.5±1.8,B组由术前的9.3±2.1提高到术后的13.1±2.5,差异均有统计学意义(P＜0.05).椎管矢状径(AP)A组由术前的(10.7±2.4) mm提高至术后的(17.6±3.2) mm；B组由术前的(11.6±1.7) mm提高至术后的(15.9±2.0) mm,差异均有统计学意义(P＜0.05).颈椎活动度(ROM)A组手术前后分别为(51.0±2.6)°和(45.0±3.5)°,B组分别为(52.0±1.8)°和(42.0±2.4)°,两组术前颈椎活动度差异无统计学意义(P＞0.05),术后颈椎活动度差异有统计学意义(P＜0.05).结论:颈后路单开门椎板成形术加Centerpiece钢板内固定治疗脊髓型颈椎病相对于传统颈椎榷管单开门扩大成形术(丝线缝合固定),即能更好的恢复椎管容积,又能较好的保持患者原有颈椎活动度,还能更好的改善术后JOA评分.因此相对于传统缝合固定方法具有明显的优势.

Research on minimally invasive release treatment of stenosing tenosynovitis of flexor digitorum

Objective: To evaluate the value of the Centerpiece plate in the cervical single open-door laminoplasty and compared its advantages with conventional suture fixation methods. Methods: From December 2009 to August 2011,32 patients with cervical spondylotic myelopathy were treated with operation. Of them,15 cases underwent cervical single open-door laminoplasty and Centerpiece plate fixation (group A),there were 8 males and 7 females,aged from 51 to 65 years old with an average of 60.5 years and ranged in course of disease from 2 to 15 months;17 cases underwent cervical single open-door laminoplasty and silk suture fixation (group B),there were 9 males and 8 females,aged from 49 to 66 years old with an average of 61.5 years and ranged in course of disease from 1 to 14 months. All the patients with unsteady gait symptom before operation and cervical MR imaging showed spinal cord compression and denaturation. According to standard of Japanese Orthopaedics Association (JOA) to evaluate the spinal nervers function before operation and at 6 months after operation;according to CT scan to determine the sagittal diameter(AP) of upper vertebral canal and cervical activity (ROM). Results: All the patients were followed up from 8 to 20 months with an average of 13 months. All the incisions healed well and no complications such as internal fixation loosening and breakage,spinal cord injury,reclose-door were found. Postoperative symptoms relieved obviously and MRI and CT showed vertebral canal volume expanded significantly. Operative time and blood loss in group A were respectively (155.0±12.3) min,( 407.0±11.8) ml and in group B were respectively (148.0±14.4) min,( 398.0±15.4) ml. There was no significantly difference between two groups(P>0.05). JOA score in group A improved from preoperative 9.1±2.6 to postoperative 15.5±1.8 and in group B improved from preoperative 9.3±2.1 to postoperative 13.1±2.5 (P<0.05). CT sagittal diameter (AP) in group A increased from preoperative (10.7±2.4) mm to postoperative (17.6±3.2) mm and in group B increased from preoperative (11.6±1.7) mm to postoperative (15.9±2.0) mm (P<0.05). Cervical activity (ROM) in group A before and after operation were respectively (51.0±2.6)°,( 45.0±3.5)° and in group B were respectively (52.0±1.8) and (42.0±2.4). There was no significantly difference before operation between two groups (P>0.05) and there was significantly difference after operation between two groups(P<0.05). Conclusion: Treatment of cervical spondylotic myelopathy with posterior single open-door laminoplasty and Centerpiece plate fixation can enlarge spinal canal volume,keep original cervical activity,improve postoperative JOA score. The method has obviously advantages compared with traditional suture fixation methods.