王鹏,孙立民,张凯,张志强,李思源,杨增坤.后路单开门短节段侧块螺钉内固定结合“锚定法”椎管扩大椎板成形术治疗不稳定型脊髓型颈椎病[J].脊柱外科杂志,2020,18(5):315-320. |
后路单开门短节段侧块螺钉内固定结合“锚定法”椎管扩大椎板成形术治疗不稳定型脊髓型颈椎病 点此下载全文 (Fulltext) |
王鹏 孙立民 张凯 张志强 李思源 杨增坤 |
山东省立第三医院骨科, 济南 250031 |
基金项目: |
DOI:10.3969/j.issn.1672-2957.2020.05.006 |
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摘要: |
目的 探讨后路单开门短节段侧块螺钉内固定结合“锚定法”椎管扩大椎板成形术治疗不稳定型脊髓型颈椎病(CSM)的临床疗效。方法 回顾性分析2014年1月—2016年1月采用短节段侧块螺钉内固定结合“锚定法”椎管扩大椎板成形术治疗的35例不稳定型CSM患者(A组)临床资料,并与同期采用微型钛板内固定结合椎管扩大椎板成形术治疗27例不稳定型CSM患者(B组)临床资料进行比较。记录并比较2组手术时间、术中出血量、术后引流量等临床指标及手术前后颈椎曲度、颈椎活动度(ROM)、椎管矢状径及扩大率、椎管横截面积、脊髓后移距离等影像学参数,采用日本骨科学会(JOA)评分、疼痛视觉模拟量表(VAS)评分及颈椎功能障碍指数(NDI)评估疗效,并观察术后轴性症状、C5神经根麻痹、椎板“再关门”等并发症发生情况。结果 所有手术顺利完成。2组随访时间、术中出血量、术后引流量组间比较差异无统计学意义(P > 0.05)。手术时间B组长于A组,末次随访时颈椎ROM A组优于B组,差异均有统计学意义(P < 0.05)。末次随访时,2组颈椎曲度、颈椎ROM、椎管矢状径、椎管横截面积、JOA评分、VAS评分、NDI较术前明显改善,差异均有统计学意义(P < 0.05);颈椎曲度、椎管扩大率、椎管横截面积、脊髓后移距离、JOA评分、VAS评分、NDI组间比较差异均无统计学意义(P > 0.05)。A组术后发生轴性症状2例,并发症发生率为5.71%(2/35);B组术后发生轴性症状5例、C5神经根麻痹2例,并发症发生率为25.93%(7/27);2组术后均未发生椎板“再关门”;并发症发生率组间比较差异有统计学意义(P < 0.05)。结论 后路单开门短节段侧块螺钉内固定结合“锚定法”椎管扩大椎板成形术治疗不稳定型CSM,可明显改善患者脊髓功能,维持颈椎曲度及稳定性,降低并发症发生率,临床疗效满意。 |
关键词:颈椎 颈椎病 内固定器 椎板成形术 减压术,外科 |
Posterior single-door short-segmental lateral mass screw fixation combined with“anchoring”method in laminoplasty for unstable cervical spondylotic myelopathy Fulltext |
WANG Peng SUN Li-min ZHANG Kai ZHANG Zhi-qiang LI Si-yuan YANG Zeng-kun |
Department of Orthopaedics, Shandong Provincial Third Hospital, Jinan 250031, Shandong, China |
Fund Project: |
Abstract: |
Objective To investigate the clinical efficacy of posterior single-door short-segmental lateral mass screw fixation combined with“anchoring”method in laminoplasty for the treatment of unstable cervical spondylotic myelopathy(CSM). Methods The clinical data of 35 patients with unstable CSM treated with posterior single-door short-segmental lateral mass screw fixation combined with“anchoring”method of laminoplasty(group A) from January 2014 to January 2016 were retrospectively analyzed,and the clinical data of 27 patients with unstable CSM treated by mini-titanium internal fixation combined with laminoplasty(group B) were compared. The clinical indicators such as operation time,intraoperative blood loss and postoperative drainage volume,and the imaging parameters such as cervical curvature,cervical range of motion(ROM),sagittal diameter and expansion rate of spinal canal,spinal canal cross-sectional area and spinal cord backward distance before and after operation were recorded and compared between the 2 groups. Japanese Orthopaedic Association(JOA) score,pain visual analogue scale(VAS) score and neck disability index(NDI) were used to evaluate the clinical efficacy. Postoperative complications such as axial symptoms,C5 nerve root paralysis,and lamina“reclosure”were observed. Results All the operations were completed successfully. There were no statistically significant differences in the follow-up time,intraoperative blood loss and postoperative drainage volume between the 2 groups(P > 0.05). The operation time of group B was longer than that of group A,and the cervical ROM was better in group A than group B at the final follow-up,both with a statistically significant difference(P < 0.05). At the final follow-up,cervical curvature,cervical ROM,sagittal diameter,cross-sectional area of the spinal canal,JOA score,VAS score and NDI were significantly improved in the 2 groups compared with those before surgery,and the differences were statistically significant(P < 0.05);there were no statistically significant differences in cervical curvature,spinal canal expansion rate,spinal canal cross-sectional area,spinal cord retrograde distance,JOA score,VAS score or NDI score between the 2 groups(P > 0.05). In group A,axial symptoms occurred in 2 cases,and the complication rate was 5.71%(2/35). In group B,axial symptoms occurred in 5,and C5 nerve root paralysis occurred in 2 after operation,and the complication rate was 25.93%(7/27). No lamina“reclosure”occurred in both groups. The difference in complication rate between groups was statistically significant(P < 0.05). Conclusion Posterior single-door short-segmental at lateral mass screw fixation combined with“anchoring”method for laminoplasty in the treatment of unstable CSM can significantly improve the spinal cord function,maintain the cervical curvature and stability,reduce the incidence of complications,and the clinical effect is satisfactory. |
Keywords:Cervical vertebrae Cervical spondylosis Internal fixators Laminoplasty Decompression,surgical |
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