颈后路单开门手术不同锚定节段的临床效果研究

目的研究分析颈后路单开门手术中锚定不同节段对患者神经功能改善率、颈椎活动度、轴性症状及并发症的影响。方法选择86例脊髓型颈椎病患者行“锚定法”颈后路单开门椎管扩大成形术，开门节段均为C3-7。根据锚定节段分为两组，A组48例患者，锚定节段为C3-7，使用锚定钉5枚。B组38例患者，锚定节段为C3,5,7,使用锚定钉3枚。比较两组患者神经功能改善率、颈椎活动度变化、轴性症状发生率及术后并发症。结果A组术后神经功能改善率为（56．4±18．3）％，B组为（56．8±19．6）％，A组术后颈椎活动度丢失角度为（9．27±5．42）°，B组为（9．06±4．89）°，A组轴性症状发生率为22．9％（11／48），B组为23．7％（9／38），两组各观察指标比较差异均无统计学意义（P〉0．05）。两组患者术后随访均未发现“再关门”现象。结论在“锚定法”颈后路单开门椎管成形术中，锚定3个节段与锚定5个节段相比，具有同样的神经功能改善率，且术后并发症并不增加，但降低了内固定费用，手术更加经济。

Clinical effect of different anchoring segments in posterior unilateral open-door laminoplasty

Objective To study the effect of posterior unilateral open-door laminoplasty which anchor the different segments of patients on neurological function improvement rate, cervical range of motion, axial symptoms and complications. Methods From June 2009 to April 2013,86 patients with cervical spondylotie myelopathy received posterior unilateral open-door laminoplasty by ＂anchoring＂ were selected. The open segments were C3-7. They were divided into two groups according to the anchor segments. Group A of 48 patients, anchor segments was C3-7, using 5 anchoring nails. Group B of 38 patients, anchor segments was C3,5,7, using 3 anchoring nails. The improvement rate of nerve function, ranges of neck motion, incidence of axial symptoms and postoperative complications were compared between two groups. Results The improvement rate of nerve function, loss of ranges of neck motion and incidence of axial symptoms between group A and group B had no significant difference （56.4 ± 18.3）% vs. （56.8 ± 19.6）%, （9.27 ± 5.42）° vs. （9.06 ± 4.89）° , 22.9% （11/48） vs. 23.7% （9/38）] （P 〉 0.05）. Two groups of patients with postoperative follow-up were not found ＂door re-clousure＂ phenomenon. Conclusions In the ＂anchor＂ posterior unilateral open-door laminoplasty,they have same improvement rate of neural function on anchoring 3 segments and anchoring 5 segments. The postoperative complications are not increased,but the cost of internal fixation is decreased, operation become more economical.