脊髓型颈椎病颈后路单开门椎管成形钛板固定术中门轴断裂的节段分布及对手术疗效的影响

目的探讨脊髓型颈椎病颈后路单开门椎管成形钛板固定术中门轴断裂的节段分布及对手术疗效的影响。方法回顾性分析自2014-02—2018-11采用单开门椎管成形钛板固定术治疗的216例脊髓型颈椎病,59例术中椎板门轴断裂(观察组),157例术中椎板门轴未断裂(对照组)。比较2组椎板开门角度、门轴距中线距离、并发症情况,术后3个月及末次随访时的颈椎曲度指数(Cervical curvature index,CCI)、JOA评分,术后1周及术后3个月的轴性症状疼痛VAS评分。结果 216例均顺利完成手术并获得完整随访,随访时间13~25个月,平均17.9个月。观察组椎板开门角度较对照组大,差异有统计学意义(P<0.05)。2组门轴距中线距离比较差异无统计学意义(P>0.05)。观察组81个椎板的门轴发生断裂,断裂分布节段:C₃7个,C₄20个,C₅36个,C₆14个,C₇4个。术后3个月观察组门轴融合率80.2%,术后6个月观察组门轴融合率93.8%。对照组并发症情况较观察组优,差异有统计学意义(P<0.05)。术后3个月与末次随访时2组CCI、JOA评分比较差异无统计学意义(P>0.05),对照组术后1周与术后3个月轴性症状疼痛VAS评分较观察组低,差异有统计学意义(P<0.05)。结论门轴断裂最易发生在C5节段,与开门角度过大有关,采用钛板支撑固定可以促进门轴的融合。门轴断裂不会影响神经功能恢复及颈椎曲度的维持,但会增加轴性疼痛及并发症发生率。

Distribution of hinge fracture during laminoplasty with titanium plate fixation in treatment of cervical spondylotic myelopathy and its influence on clinical efficacy

Objective To investigate the distribution of hinge fracture during laminoplasty with titanium plate fixation in treatment of cervical spondylotic myelopathy and its influence on clinical efficacy.MethodsA total of 216 patients with cervical spondylotic myelopathy who underwent laminoplasty in our hospital from February 2014 to November 2018 were retrospective analyzed. The hinge was fractured in 59 cases(observation group), and the hinge was integrated in 157 cases(control group). The two groups of lamina door opening angle, door axis distance to the midline, and complications were compared. The cervical curvature index(CCI) and JOA score of the two groups at 3 months after surgery and at the last follow-up were compared. The axial symptom pain VAS score in the last 1 week and 3 months after operation were compared between the two groups.ResultsAll216 cases were operated successfully and obtained a complete follow-up. The follow-up time was 13-25 months, with an average of 17.9 months. The opening angle in observation group was larger than that in control group(P<0.05). There was no significant difference in the hinge position between the 2 groups(P>0.05). In observation group, the hinge fracture occurred in 81 segments, 7 segments in C₃, 20 segments in C₄, 36 segments in C₅, 14 segments in C₆, and 4 segments in C₇. The hinge fusion rate was 80.2% and 93.8% at 3 months and at 6 months after operation. There was no significant difference in CCI and JOA score between the two groups at 3 months after surgery and at the last follow-up(P>0.05). The axial symptom based on pain VAS score in control group was lower than that in observation group at 1 week and 3 months after surgery(P<0.05).Conclusion hinge fracture is most likely to occur in the C5 level and is related to the excessive opening angle. The use of titanium plate can promote the hinge fusion rate. The hinge fracture will not affect the neurological recovery and the cervical curvature maintenance, but it will increase the axial pain and complication rate.