摘要
目的椎板成形术已广泛应用于后纵韧带骨化和颈椎椎管狭窄脊髓病的外科治疗中,影响开门技术广泛应用的一大障碍是缺乏合适的固定系统把骨折椎板固定在侧块上。我们的目的是探讨颈椎侧块螺钉结合棘突椎板螺钉内固定技术在颈椎管扩大成形术的可行性,并报告初步临床效果。方法对我院2008年5月至2010年12月收治的具有完整资料12例颈椎病患者实施一种新型的颈后路椎板成形术(颈椎侧块螺钉结合棘突椎板螺钉组合固定),其中多节段脊髓型颈椎病(cervical spondylotic myelopathy,MCSM)3例,颈椎后纵韧带骨化症(ossification of posteriorlongitudinal ligament,OPLL)3例,急性中央型颈髓损伤综合征(acute cervical cord injury syn-drome,ATCCS)4例,发育性颈椎椎管狭窄(developmental cervical stenosis,DCS)伴脊髓损伤2例。手术减压范围:C3～73例,C3～68例,C3～51例。左侧开门5例,右侧开门7例。椎板抬起后,用Vertex系统中的万向螺钉行同侧同一节段的颈椎侧块螺钉及棘突椎板螺钉内固定,然后用连接棒桥架于颈椎侧块螺钉及棘突椎板螺钉卡槽中间,并用撑开器适当撑开以扩大椎管容积。神经功能的情况用日本整形外科学会的JOA评分(17分法)进行评估。结果所有病例术后均获得随访,平均随访时间为15.2个月(6～28个月)。患者临床症状均得到不同程度的改善。平均手术时间120min(90～150min),平均失血量1 400mL(800～4 300mL)。术中无因内固定植入引起神经血管损伤,术后1例出现轴性症状,1例出现短暂C5神经根麻痹,6周后症状明显缓解。术后1个月JOA评分由术前9.2分(范围7～12分)提高到12.9分(范围9～15分),JOA改善率为44.2%(范围20.0%～60.0%);术后3个月提高到14.3分(范围12～16分),JOA改善率为62.4%(范围44.0%～80.0%)。其中优(大于等于75%)3例,占25%;良(范围50%～74%)8例,占66.7%;可(25%～49%)1例,占8.3%,术后6个月改善不明显。手术后CT显示�
Objective Laminoplasty is well described as a surgical option for treating ossification of the posterior longitudinal ligament（OPLL） and cervical stenotic myelopathy.An obstacle to the open door technique widespread use is the lack of a suitable fixation systems to adequately secure the fractured lamina to the lateral mass.Our objective was to analyse the feasibility of a novel open-door laminoplasty with internal fixation of lateral mass screw combine with process and lamina screw,and report the initial clinical effect.Methods 12 consecutive patients with cervical spondylosis between May 2008 and December 2010 were involved in this study.All cases were performed a novel open-door laminoplasty with internal fixation of lateral mass screw combine with process and lamina screw.Three cases were multiple segments cervical spondylotic myelopathy,Three cases were ossification of posterior longitudina ligament of cervical spine,Four cases were acute traumatic central cervical spinal cord syndrome,Two cases were cervical development stenosis combined with spinal cord injury.The scope of operation decompression：C3～7 3 cases,C3～6 8 cases,C3～5 1 case.5 cases were opened door in left side,7 cases were opened door in right side.After the vertebral lamina was lift up,lateral mass screw combine with spinal process and vertebral lamina screw were fixed on the same segment of the same lateral side with polyaxial screw of the Vertex System,then there was no need to bite off the spinous process and the supraspinallig.Results All patients were followed up for about 15.2 months（6 to 28 months）.All patients,clinical symptom were improved.The average operation time prolonged 120 minutes（90 to 150 minutes）,the average blood losing volume was 1 400 mL（800～4 300 mL）.There are no nerve and blood vessel injury during the operation.During the follow-up period,we found 1 case have the pivotal symptom,1 case has brief nerve root paralysis of C5,all these syndromes were relieved after 6 weeks.The mean JOA score of 12 p
出处
《实用骨科杂志》
2011年第10期865-869,932,共6页
Journal of Practical Orthopaedics
关键词
颈椎病
椎管狭窄
椎管扩大成形
后路
内固定
cervical spondylosis
vertebral canal stenosis
laminoplasty technique
posterior approach
internal fixation
