摘要
目的观察单开门微型钛板固定椎管成形术中重建伸肌附着点的临床意义及在治疗脊髓型颈椎病中的效果。方法研究对象为2012年5月至2013年10月共39例脊髓型颈椎病患者,男26例,女13例;年龄44~76岁,平均63.5岁;两节段受压6例,三节段19例,四节段14例。均接受行单开门微型钛板固定椎管成形术,术中重建颈后伸肌群附着点。随访时间14~45个月,术前、术后3个月及末次随访时观察患者神经功能恢复、轴性症状发生情况,X线片测量颈椎曲度指数(CCI),MRI测量颈后肌群横截面积了解颈后肌群萎缩情况,日本骨科协会(JOA)脊髓损害评分表评估神经功能改善率。结果所有患者均顺利完成手术,未出现脊髓及神经损伤情况。手术时间86~140(113.7±34.9)min;术中出血190~430(296±113.5)ml。随访时间14~45个月,随访过程中无钛板松动、折断及开门再闭现象发生。患者JOA评分由术前的(8.3±2.6)分恢复为术后3个月时的(13.5±3.4)分及末次随访时的(13.8±3.7)分,手术前后比较差异有统计学意义(P<0.05);神经功能改善率为(59.8±17.5)%。术前CCI为(16.8±4.3)%,末次随访时减小为(15.1±4.6)%,差异无统计学意义(P>0.05);术前患者颈后肌群横截面积为(36.2±9.5)cm2,术后为(34.6±9.7)cm2,差异无统计学意义(P>0.05)。术后共6例(15.3%)患者出现轴性症状,给予非甾体类药物及理疗后症状逐步消失;末次随访时根据轴性症状评定标准:优16例,良17例,可5例,差1例。结论单开门微型钛板固定术中重建伸肌附着点可有效减轻脊髓压迫、促进神经功能恢复、降低术后轴性症状的发生。该术式在保护颈伸肌群和减少颈椎前凸丢失方面的作用有待进一步扩大样本量探讨。
Objective To investigate the significance and clinical effects of reconstruction of extensor muscles attachment points in hemiexpansive laminoplasty with mini titanium plate fixation in the treatment of cervical spondylotic myelopathy （CSM）. Methods A total of 39 CSM patients （26 males and 13 females ; aged 44 to 76 years with an average age of 63.5 years ; number of compressed vertebral segments ： two segments in 6 cases, three segments in 19 eases, four segments in 14 cases ） from May 2012 to October 2013 were selected as research objects. All patients received hemiexpansive laminoplasty with mini titanium plate fixation and reconstruction of cervical posterior extensor group attachment points in the operation. All patients were followed up for 14 to 45 months. The recovery of nerve functions and the situation of axial symptoms before operation, three months after operation and at the last follow-up were observed. Cervical curvature index（CCI） was measured with X-ray photograph. Cross-sectional area of cervical posterior extensor group was measured by MRI to know about the arophy conditions of cervical posterior extensor group. Nerve function improvement rate was assessed by spinal cord injury scale of Japanese Orthopaedic Association （JOA）. Results The operation was completed successfully in all patients, and no spinal cord injury and nerve injury occurred. The operation time was 86 -140（ 113.7 ± 34.9 ）min. Intraoperative blood loss was 190 - 430 （296 ± 113.5 ） ml. No phenomenon of loosening and breaking of titanium plate and re-closing of expan- sive vertebral plate occurred during follow-up. The scores of JOA improved from（8.3 ± 2.6 ）pre-operation to（ 13.5 ± 3.4） 3 months after operation and（ 13.8 ± 3.7 ） at the last follow-up in which there was significant difference before and after op- eration（P 〈0.05 ）. Nerve function improvement rate was （59.8 ± 17.5 ）%. There was no significant difference in CCI between pre-operation [ （16.8 ± 4.3 ）% ] and last
出处
《中国临床研究》
CAS
2017年第4期451-454,共4页
Chinese Journal of Clinical Research
基金
河北省医学科学研究重点课题计划(20150452)
关键词
脊髓型颈椎病
微型钛板固定椎管成形术
棘突肌肉附着点
重建
轴性症状
颈椎曲度指数
颈后
肌群横截面积
Cervical spondylotic myelopathy
Laminoplasty with mini titanium plate fixation
attachment points of spi-nous muscles
Reconstruction
Axial symptom
Cervical curvature index
Cross-sectional area of cervical posterior exten-sor group
