摘要
目的比较3种固定方式在颈后路单开门椎管扩大术治疗多节段颈椎管狭窄症中的应用特点及临床疗效。方法将44例手术患者按固定方式分为三组:A组微型钢板固定11例,B组带线锚钉固定15例,C组普通螺钉固定18例,记录三组患者手术时间、术中出血量、住院时间、治疗费用、JOA评分、颈椎管横截面积、颈椎活动度(range of motion,ROM)、颈椎曲率指数(cervical curvature index,CCI)及手术并发症情况。并评价术后3年时神经功能改善率。结果A组手术时间、术中出血量及治疗费用均显著多于B、C组,住院时间显著短于B、C组(P<0.001);B组的治疗费用显著多于C组(P<0.001)。术后3年,A组JOA评分、颈椎管横截面积均显著大于B、C组(P<0.05),B组和C组之间差异无统计学意义(P>0.05)。术后3年,A组颈椎ROM和CCI均显著大于B、C组(P<0.001),B组和C组之间差异无统计学意义(P>0.05)。并发症方面,A组术后发热1例,B组术后脑脊液漏2例,C组术中硬脊膜撕裂1例,术后C5神经根麻痹1例。结论3种固定方式治疗多节段颈椎管狭窄症均可取得满意疗效,其中普通螺钉手术操作简单、治疗费用低,微型钢板固定更牢固、疗效更佳,但操作费时、创伤大、费用高。
Objective To compare the characteristics and clinical effect of three kinds of fixation methods combined with unilateral open-door cervical expansive laminoplasty in the treatment of multiple segmental cervical spinal stenosis.Methods Forty-four patients with multiple segmental cervical spinal stenosis were divided into three groups according to the fixation methods:group A(miniature titanium plate)comprised 11 patients,group B(suture anchor)comprised 15 patients,group C(common screw)comprised 18 patients.The operation time,intraoperative blood loss,hospitalization time,hospitalization cost,JOA score,cervical spinal canal cross-sectional area,cervical range of motion(ROM),cervical curvature index(CCI)and surgical complications of three groups were recorded.The neurological function improvement rate was evaluated at three years after operation.Results The operation time,intraoperative bleeding and treatment cost of group A were significantly higher than those of group B and group C,and the hospital stay was significantly shorter than that of group B and group C(P<0.001).The treatment cost of group B was significantly higher than that of group C(P<0.001).Three years after operation,the JOA score and the cross-sectional area of the cervical canal in group A were significantly higher than those in group B and group C(P<0.05),and there was no significant difference between group B and group C(P>0.05).Three years after operation,the ROM and CCI of cervical vertebra in group A were significantly higher than those in group B and group C(P<0.001),and there was no significant difference between group B and group C(P>0.05).In terms of complications,there was 1 case of postoperative fever in group A,2 cases of postoperative cerebrospinal fluid leakage in group B,1 case of intraoperative dural tear in group C,and 1 case of postoperative C5 nerve root paralysis.Conclusion Three kinds of fixation methods can achieve satisfactory clinical results in the treatment of multiple segmental cervical spinal stenosis.The screw group has
作者
黄长智
林久灶
黄兆曦
魏林文
黄聿峰
周长嵩
陈挺霖
吴迪
林泉
HUANG Chang-zhi;LIN Jiu-zao;HUANG Zhao-xi;WEI Lin-wen;HUANG Yu-feng;ZHOU Chang-song;CHEN Ting-lin;WU Di;LIN Quan(the First Department of Orthopedics,Ningde Hospital Affiliated to Ningde Normal University,Ningde,Fujian 352100,China)
出处
《颈腰痛杂志》
2023年第1期42-45,共4页
The Journal of Cervicodynia and Lumbodynia
基金
福建省卫生计生科研人才培养项目资助(编号:2018-2-58)
宁德市科技计划项目(编号:20170064)。
关键词
颈椎管狭窄症
单开门椎管扩大成形术
内固定
临床疗效
cervical spinal stenosis
single open-door laminoplasty
internal fixation
clinical efficacy
