| 王鹏,张凯*,孙立民,张志强,徐峥,李思源.短节段侧块螺钉内固定结合“锚定法”后路单开门椎管扩大椎板成形术治疗不稳定性多节段脊髓型颈椎病[J].脊柱外科杂志,2020,18(1):24-28. |
短节段侧块螺钉内固定结合“锚定法”后路单开门椎管扩大椎板成形术治疗不稳定性多节段脊髓型颈椎病  点此下载全文 (Fulltext) |
| 王鹏 张凯* 孙立民 张志强 徐峥 李思源 |
| 山东省立第三医院脊柱外科, 济南 250031 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2020.01.006 |
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| 摘要： |
| 目的 探讨短节段侧块螺钉内固定联合“锚定法”后路单开门椎管扩大椎板成形术治疗不稳定性多节段脊髓型颈椎病（MCSM）的疗效。方法 回顾性分析2015年1月—2016年6月接受短节段侧块螺钉内固定联合“锚定法”后路单开门椎管扩大椎板成形术治疗的35例不稳定性MCSM患者临床资料，记录手术时间、术中出血量、术后引流量、住院时间及并发症发生情况，在手术前后影像学图像上测量C2~7 Cobb角、颈椎活动度（ROM）、椎管矢状径及椎管横截面积，并计算椎管扩大率。采用日本骨科学会（JOA）评分及其改善率评价术后神经功能改善情况，采用疼痛视觉模拟量表（VAS）评分及颈椎功能障碍指数（NDI）评价患者疼痛及功能改善情况。结果 所有手术均顺利完成。患者随访18个月；手术时间（93.0±21.5）min，术中出血量（189.5±35.1）mL，术后引流量（169.4±15.6）mL，住院时间（8.5±0.8）d。术后C2~7 Cobb角、椎管矢状径、椎管横截面积、JOA评分、VAS评分及NDI较术前明显改善，差异均有统计学意义（P<0.05）；椎管扩大率为（72.6±11.5）%，JOA评分改善率为（81.5±5.3）%。术后颈椎ROM与术前相比差异无统计学意义（P>0.05）。术后发生颈部轴性疼痛6例，C5神经根麻痹1例。所有患者未发生螺钉及铆钉松动、脱落，扩大的椎管再关闭现象或其他并发症。术后影像学资料显示骨融合良好。结论 短节段侧块螺钉内固定联合“锚定法”后路单开门椎管扩大椎板成形术治疗MCSM能明显改善患者脊髓功能，维持颈椎曲度及稳定性，疗效确切。 |
| 关键词：颈椎 颈椎病 内固定器 减压术，外科 |
| Short-segmental lateral mass screw fixation combined with “anchoring” posterior single-door laminoplasty for unstable multilevel cervical spondylotic myelopathy Fulltext |
| WANG Peng ZHANG Kai* SUN Li-min ZHANG Zhi-qiang XU Zheng LI Si-yuan |
| Department of Orthopaedics, Shandong Provincial Third Hospital, Jinan 250031, Shandong, China |
| Fund Project: |
| Abstract: |
| Objective To investigate the efficacy of short-segmental lateral mass screw fixation combined with " anchoring" posterior single-door laminoplasty for unstable multilevel cervical spondylotic myelopathy (MCSM). Methods From January 2015 to June 2016, the clinical data of 35 unstable MCSM patients treated with short-segmental lateral mass screw fixation combined with" anchoring"posterior single-door laminoplasty were analyzed retrospectively. Operation time, intraoperative blood loss, postoperative drainage volume, hospital stay and complications were recorded. C-7 Cobb's angle, cervical range of motion (ROM), sagittal diameter and cross-sectional area of the spinal canal were measured before and after operation, and the enlargement rate of the spinal canal was calculated. Japanese Orthopaedic Association (JOA) score and its improvement rate were used to evaluate postoperative neurological function improvement. Visual analogue scale(VAS) score and neck disability index (NDI) were used to evaluate pain and functional improvement in patients. Results All the operations were successfully completed. Patients were followed up for 18 months. Operative time was (93.0±21.5) min; intraoperative blood lo ss was (189.5±35.1) mL; postoperative drainage volume was (169.4±15.6) mL; and hospital stay was (8.5±0.8) d. C-7 Cobb's angle, sagittal diameter and cross-sectional area of the spinal canal, JOA score, VAS score and NDI were significantly improved after operation, with statistically significant differences (P<0.05). The enlargement rate of the spinal canal was (72.6±11.5)% and the improvement rate of JOA score was (81.5±5.3)%. There was no significant difference in cervical ROM after operation compared with that before operation (P>0.05). Postoperative neck pain occurred in 6 cases and C5 nerve root paralysis in 1. No screw/rivet loosening/falling off, enlarged spinal canal re-closure or other complications occurred in all the patients. Postoperative imaging data showed good bone healing. Conclusion Short-segmental lateral mass screw fixation combined with " anchoring"posterior single-door laminoplasty can significantly improve spinal cord function, maintain cervical curvature and stability, and has an effective effect in MCSM patients. |
| Keywords:Cervical vertebrae Cervical spondylosis Internal fixators Decompression, surgical |
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