＂锚定法＂单开门椎管成形术治疗多节段颈椎管狭窄症的疗效分析

目的：评价＂锚定法＂单开门颈椎管成形术的临床疗效.方法：2001年1月至2008年12月,对本院骨科86例颈椎病伴多节段椎管狭窄患者行后正中入路＂锚定法＂单开门椎管成形术.在门轴一侧的侧块上置入Depuy锚定钉,螺钉置入侧块后将丝线一端经棘突根部的预穿孔穿过,开门后拉紧丝线并打结,使椎板保持在开门状态.结果：平均随访17.2个月（6个月至3年）.术前JOA评分7-10分,平均8.6分,术后JOA评分13～15分,平均14.2分,JOA评分改善率：60～75%,平均67%.术后侧位X线片测量椎管矢状径扩大4.5～6.4 mm,平均5.5 mm,椎管扩大率51.1%～73.9%,平均62.5%,MR示脊髓解除压迫.末次随访时29例仍然有颈部疼痛、僵硬感和活动受限.未见螺钉松动和再＂关门＂现象.结论：＂锚定法＂椎管成形术操作简单、在维持开门角度的稳定性以及防止再关门、减轻术后颈部疼痛、僵硬等轴性症状方面具有明显的优势.

Modified expansive open door laminoplasty using anchor method for the treatment of multi-segmental cervical spondylotic myelopathy

Objective： To evaluate the clinical effect of modified expansive open door laminoplasty using anchor method for the treatment of multi-segmental cervical spondylotic myelopathy . Method： 86 cervical spondylosis patients with multi-segmental cervical spinal canal stenosis underwent modified expansive open door laminoplasty using anchor method in posterior central approach during January 2001 and December 2008. Depuy anchor screws （a titanium screw） was inserted over one lateral of axis, and then a surgical suture was threaded over pre-punch by the root of processus spinosus. After opening the door and tensing the suture, ligation was performed so as to keep the door open. Result：Mean follow up was 17.2 months （6 to 36 months）. Preoperative JOA score range was 7 - 10 ,with mean JOA score at 8.6. Postoperative JOA range was 13 - 15 ,with mean score at 14.2. The improved JOA rate ranged from 60% to 75% , with average at 67%. Postoperative lateral X-ray films showed the spinal canal diameter expanded 4.5-6.4mm,with mean at 5.5mm, showing a spinal canal expansion rate of 51.1- 73.9% and average at 62.5%. MR film showed that spinal cord compression was released. There were still 29 cases suffered from neck pain,stiffness and limitation of neck motion in the final follow-up. Neither loosened screw nor door reclosure was observed. Conclusion： Modified expansive open door laminoplasty using anchor method is easy to use, and it is superior in maintaining stability of door open angle, in preventing door re-closure and releasing postoperative axial symptoms such as neck pain and stiffness