下颈椎棘突椎板螺钉在单开门椎管扩大术中的临床应用

目的:探讨下颈椎棘突椎板螺钉技术在单开门椎管扩大术中的临床应用及疗效。方法:2005年2月至2010年6月,采用下颈椎棘突椎板螺钉技术治疗颈椎病12例,男7例,女5例;年龄34～78岁,平均56岁;其中前方椎间盘退变突出合并退变性椎管狭窄者6例,后纵韧带骨化伴骨赘形成者5例,颈椎外伤性失稳伴脊髓损伤1例。对患者临床疗效和影像学情况进行评估,包括神经功能(依照JOA评定),术后并发症,颈椎各节段矢状径比例、屈伸活动范围及矢状序列的改变(利用影像学资料进行测量)。结果:手术时间1.5～2h,平均110min;术中出血量450～800ml,平均580ml。术后出现上肢疼痛l例,脑脊液漏1例。12例均获随访,时间1～2年,平均21.8个月。JOA评分术前为(9.5±1.8)分,术后为(13.6±2.4)分(P<0.01)。术后CT、MRI显示颈椎管矢状径比例增加(P<0.01)。颈椎屈伸活动范围、前凸比例由术前的(40.0±10.0)°、(65.0±12.0)%降至术后的(15.0±5.0)°、(42.0±8.0)%(P<0.01)。结论:下颈椎棘突椎板螺钉技术应用于单开门椎管扩大术中治疗颈椎病能取得满意疗效,相对安全、操作简单,并且具有较强内固定、可防止再关门。

Clinical application of lower cervical spinous process laminar screw technique in open door laminoplasty

Objective: To investigate the clinical outcomes of lower cervical spinous process laminar screw technique in open door laminoplasty. Methods: From February 2005 to June 2010,12 patients with cervical myelopathy were treated with open door laminoplasty by lower cervical spinous process laminar screw technique. There was intervertebral disc herniation with degenerative stenosis in 5 patients,ossification of posterior longitudinal ligament with osteophyte in 6 patients,cervical traumatic instability with spinal cord injuries in 1 patient. Nerve function,complications,and the cervical canal to body ratio (CBR),range of motion (ROM) and the anteroposterior serial alignment were observed by Japanese Orthopedic Association(JOA) score,X-ray,CT and MRI. Results: The surgical time was from 1.5 to 2 h with an average of 110 min;blood loss during operation was from 450 to 800 ml with an average of 580 ml. Postoperative complication occurred in 1 case with upper limb pain and 1 case with cerebrospinal fluid leakage. All patients were followed up from 1 to 2 years with an average of 21.8 months. JOA score improved from preoperative 9.5±1.8 to postoperative 13.6±2.4(P < 0.01). X-ray,CT,MRI showed CBR increased obviously(P < 0.01); ROM on flexion-extension and cervical lordosis decreased respectively from (40.0±10.0)°and (65.0±12.0)% before operation to (15.0±5.0)° and (42.0±8.0) % at the final follow-up (P < 0.01). Conclusion: Lower cervical spinous process laminar screw technique in open door laminoplasty for cervical syndrome is safe and can obtain satisfactory effects,has strong internal fixation and reduce the risk of re-closure.