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朱程樟,刘永刚,杨建,刘铁龙,肖建如.颈椎单开门椎板成形术中铰链侧断裂后采用新型棘突悬吊法固定的临床疗效[J].脊柱外科杂志,2021,19(2):83-88.
颈椎单开门椎板成形术中铰链侧断裂后采用新型棘突悬吊法固定的临床疗效     点此下载全文 (Fulltext)
朱程樟1  2  刘永刚2  杨建2  刘铁龙2  肖建如2*
1. 安徽中医药大学研究生院, 合肥 230038;
2. 海军军医大学长征医院骨肿瘤科, 上海 200003
基金项目:国家自然科学基金面上项目(81972506)
DOI:10.3969/j.issn.1672-2957.2021.02.003
摘要点击次数: 124
全文下载次数: 19
摘要:
      目的 探讨颈椎单开门椎板成形术中铰链侧断裂后采用新型棘突悬吊法固定的临床疗效。方法 2016年6月—2019年4月,海军军医大学长征医院采用ARCH钢板并单节段椎板成形术治疗多节段颈椎椎管狭窄症患者,术中发生铰链侧椎板断裂(≤2个节段)30例。早期发生铰链侧椎板断裂的15例患者未行任何处理(对照组),后期的15例患者采用新型棘突悬吊法固定(试验组)。记录并比较2组手术时间、术中出血量、术后引流量,术前及术后3个月疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分、颈椎功能障碍指数(NDI)、C2~7 Cobb角、颈椎曲度、颈椎活动度(ROM),以及术后并发症(轴性疼痛、感染、C5神经根麻痹、术后6个月椎板未愈合)发生情况。结果 所有患者随访10~35个月,平均20个月。对照组手术时间、术中出血量均少于试验组,差异有统计学意义(P<0.05)。2组术后3个月VAS评分、JOA评分、NDI、C2~7 Cobb角、颈椎曲度及颈椎ROM均较术前显著改善,差异有统计学意义(P<0.05)。试验组术后3个月VAS评分、JOA评分、NDI及颈椎ROM均优于对照组,差异有统计学意义(P<0.05)。术后发生轴性疼痛者,对照组7例,试验组1例,差异有统计学意义(P<0.05)。术后6个月椎板未愈合者,对照组6例,试验组3例,差异无统计学意义(P>0.05)。结论 颈椎单开门椎板成形术中铰链侧椎板断裂后采用新型棘突悬吊法固定更有利于降低患者术后颈椎功能障碍发生率,保留颈椎ROM,减少轴性疼痛的发生。
关键词:颈椎  颈椎病  椎板成形术
Clinical efficacy of new spinous process suspension method for hinge side fracture in single-door cervical laminoplasty    Fulltext
Zhu Chengzhang1  2  Liu Yonggang2  Yang Jian2  Liu Tielong2  Xiao Jianru2*
1. Graduate School, Anhui University of Traditional Chinese Medicine, Hefei 230038, Anhui, China;
2. Department of Bone Tumor, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
Fund Project:
Abstract:
      Objective To investigate the clinical efficacy of a new spinous process suspension method for hinge side fracture in single-door cervical laminoplasty. Methods From June 2016 to April 2019,ARCH plate and single-door cervical laminoplasty were used in the treatment of multi-segment cervical spinal stenosis in Changzheng Hospital Affiliated to Navy Medical University. During the operation,30 cases of hinge side lamina fracture(≤ 2 segments) occurred. In the early stage,15 patients with hinge side lamina fracture did not receive any treatment(control group),and in the later stage,15 patients were fixed with new spinous process suspension method(experiment group). The operation time,intraoperative blood loss,postoperative drainage volume,and visual analogue scale(VAS) score,Japanese Orthopaedic Association(JOA) score,neck disability index(NDI),C2-7 Cobb's angle,cervical curvature and cervical range of motion(ROM) at pre-operation and postoperative 3 months,and postoperative complications(axial pain,infection,C5 nerve root palsy,and lamina nonunion at 6 months after operation) were recorded and compared between the 2 groups. Results All the patients were followed up for 10-35 months,with an average of 20 months. The operation time and intraoperative blood loss of the control group were less than those of the experiment group,all with a statistical significance(P<0.05). The VAS score,JOA score,NDI,C2-7 Cobb's angle,cervical curvature and ROM of the 2 groups were significantly improved at postoperative 3 months compared with those at pre-operation,all with a statistical significance(P<0.05). The VAS score,JOA score,NDI and cervical ROM at postoperative 3 months in the experiment group were better than those in the control group,and the differences were statistically significant(P<0.05). There were 7 cases of axial pain in the experiment group,and 1 in the control group,and the difference was statistically significant(P<0.05). There were 6 cases with lamina nonunion at 6 months after operation in the control group and 3 in the experiment group,and the difference was not statistically significant(P>0.05). Conclusion The new spinous process suspension method for hinge side fracture in single-door cervical laminoplasty is more conducive to reduce the incidence of postoperative cervical dysfunction,preserve the cervical ROM and reduce the occurrence of axial pain.
Keywords:Cervical vertebrae  Cervical spondylosis  Laminoplasty
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