颈椎椎管成形术结合微型钛板治疗多节段颈椎病

目的评价颈椎椎管成形术结合微型钛板治疗多节段颈椎病的疗效。方法采用颈椎后路单开门结合微型钛板内固定治疗多节段颈椎病患者21例，对术前和术后JOA评分、椎管矢状径、颈椎生理曲度等指标进行统计学分析。结果21例患者均获随访，时间9～48个月，未见严重并发症。术后6个月CT提示铰链侧骨质愈合；末次随访根据JOA评分法进行疗效评价：优9例，良7例，可3例，差2例，末次随访JOA改善率达62．5％；颈椎管矢状径术前为（9．2±1．1）mm，术后1个月为（13．5±1．4）mm，术后1个月与术前比较差异有统计学意义（t=3．02，P〈0．01），术后各期无明显变化（P〉0．05）；颈椎曲度术前为（12．6±14．7）。，末次随访为（17．1±12．4）。末次随访与术前比较差异有统计学意义（t=8．26，P〈0．01），术后6个月内颈椎曲度改变不明显（P〉0．05）。结论颈椎椎管成形术结合微型钛板治疗多节段颈椎病，能够有效的扩大并维持椎管矢状径，改善颈椎生理曲度，改善脊髓神经功能。

Cervical laminoplasty using titanium miniplate for multisegmental cervical spondylotic myelopathy

Objective To evaluate the clinical outcome of cervical laminoplasty using titanium miniplate （AO arch） for the treatment of muhisegmental cervical spondylotic myelopathy （MCSM）. Methods 21 patients with MCSM were operated by cervical posterior unilateral open-door laminoplasty combined with titanium miniplate internal fixation. The JOA score, sagittal diameter of the spinal canal in the midline （SD） and cervical curvature index according to the measurement of Penning method before surgery and at postoperative follow-up intervals were measured and compared by one-way analysis of variance. Results All patients were followed up for 9 - 48 months. There were no severe adverse events. CT scan showed bony fusion at hinge side since six months after operation. According to the JOA score evaluation system, at final follow-up period, 9 cases were excellent, 7 good, 3 ordinary and 2 cases bad. Recovery rate was 52. 5% at final follow-up interval. Cervical SD before surgery and in postoperative one month were （9.2 ± 1.1 ） mm, （ 13.5 ±1.4） mm, respectively. The difference was significant between them （ t = 3.02, P 〈 0. 01 ）, but there was no improvement since one month postoperatively （ P 〉 0. 05 ）. Cervical curvature index was （ 12. 6 ± 14. 7）. preoperatively, it was （ 17.1 ±12.4 ）. at final follow-up interval, indicating that cervical curvature index made obvious progress at final follow-up interval （ t = 8.26, P 〈 0. 01 ）, but there was no significant change within six months postoperatively （ P 〉 0. 05 ）. Conclusions Cervical laminoplasty combined with titanium miniplate can enlarge and maintain cervical SD, ameliorate cervical curvature and neurological function, and it is an ideal alternative treatment for MCSM.