| 曹勇,李信,顾红林,陈志刚,吕书军.颈椎后路椎管扩大椎板成形术联合单侧椎弓根螺钉短节段内固定术治疗MRI T2WI高信号无骨折脱位型颈椎脊髓损伤[J].脊柱外科杂志,2024,22(2):117-122. |
颈椎后路椎管扩大椎板成形术联合单侧椎弓根螺钉短节段内固定术治疗MRI T2WI高信号无骨折脱位型颈椎脊髓损伤  点此下载全文 (Fulltext) |
| 曹勇1 李信1 顾红林2 陈志刚1 吕书军1* |
1. 海安市人民医院骨科, 南通 226600;
2. 盐城市第三人民医院骨科, 盐城 224008 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2024.02.008 |
| 摘要点击次数: 34 |
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| 摘要： |
| 目的 比较颈椎后路椎管扩大椎板成形术联合单侧椎弓根螺钉短节段内固定术与颈椎前路减压植骨融合内固定术治疗MRI T2WI高信号无骨折脱位型颈椎脊髓损伤（SCI）的临床疗效。 方法 2014年1月—2017年1月海安市人民医院收治MRI T2WI高信号无骨折脱位颈椎SCI患者89例，其中43例采用颈椎后路椎管扩大椎板成形术联合单侧椎弓根螺钉短节段内固定术治疗（后路组），46例采用颈椎前路减压植骨融合内固定术治疗（前路组）。记录2组手术时间、术中出血量，手术前后颈椎活动度（ROM）、脊髓横截面积、椎管面积残余率、髓内高信号强度比值，手术前后采用日本骨科学会（JOA）评分和颈椎功能障碍指数（NDI）评价疗效。 结果 所有手术顺利完成，所有患者随访时间＞ 24个月。2组手术时间、术中出血量差异无统计学意义（P ＞ 0.05）。末次随访时，2组脊髓横截面积、椎管面积残余率、髓内高信号强度比值、JOA评分和NDI较术前显著改善，且后路组颈椎ROM、椎管面积残余率、NDI和NDI改善率优于前路组，差异均有统计学意义（P ＜ 0.05）。 结论 2种术式均可有效治疗MRI T2WI高信号无骨折脱位型颈椎SCI，但颈椎后路椎管扩大椎板成形术联合单侧椎弓根螺钉短节段内固定术在术后远期生活质量改善方面更胜一筹，同时可更好地保留颈椎ROM。 |
| 关键词：颈椎|脊髓损伤|减压术，外科|脊柱融合术|内固定器 |
| Posterior cervical laminoplasty combined with unilateral pedicle screw short-segment internal fixation for treatment of MRI T2WI high signal cervical spinal cord injury without fracture and dislocation Fulltext |
| Cao Yong Li Xin Gu Honglin Chen Zhigang Lü Shujun |
1. Department of Orthopaedics, Haian People's Hospital, Nantong 226600, Jiangsu, China;
2. Department of Orthopaedics, Yancheng Third People's Hospital, Yancheng 224008, Jiangsu, China |
| Fund Project: |
| Abstract: |
| Objective To compare the clinical efficacy of posterior cervical laminoplasty combined with unilateral pedicle screw short-segment internal fixation and anterior cervical decompression and bone grafting fusion internal fixation in the treatment of MRI T2WI high signal cervical spinal cord injury（SCI） without fracture and dislocation. Methods From January 2014 to January 2017，Haian People’s Hospital admitted 89 patients with MRI T2WI high signal cervical SCI without fracture and dislocation. Among them，43 patients were treated with posterior cervical laminoplasty combined with unilateral pedicle screw short-segment internal fixation（posterior group），and 46 with anterior cervical decompression and bone grafting fusion internal fixation（anterior group）. The operation time，intraoperative blood loss，preoperative and postoperative cervical range of motion（ROM），cross-sectional area of the spinal cord，residual rate of spinal canal area，and intramedullary high signal intensity ratio of the 2 groups were recorded. The Japanese Orthopaedic Association（JOA） score and the neck disability index（NDI） were ued to evaluate the therapeutic effect. Results All the surgeries were successfully completed，and all the patients were followed up for more than 24 months. There was no statistically significant difference in operation time and intraoperative blood loss between the 2 groups（P ＞ 0.05）. At the final follow-up，both groups showed significant improvements in cross-sectional area of the spinal cord，residual rate of spinal canal area，intramedullary high signal intensity ratio，JOA score and NDI compared to the pre-operation；in addition，the cervical ROM，residual rate of spinal canal area，NDI and improvement rates of NDI at the final follow-up in the posterior group were better than those in the anterior group；the differences were statistically significant（P ＜ 0.05）. Conclusion Both methods can effectively treat MRI T2WI high signal cervical SCI without fracture or dislocation，but posterior cervical laminoplasty combined with unilateral pedicle screw short-segment internal fixation is superior in improving long-term quality of life and better preserving cervical ROM. |
| Keywords:Cervical vertebrae|Spinal cord injuries|Decompression,surgical|Spinal fusion|Internal fixators |
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