摘要
背景:临床上使用颈椎单开门椎管扩大成形修复慢性压迫性颈脊髓病效果确切。为减少修复后并发症的发生,临床医生提出了不同的改良修复方案,虽具有一定效果,但对减少修复后并发症方面疗效欠佳。目的:评价保留双侧半棘肌的改良肌间隙修复入路在颈椎单开门椎管扩大成形钢板置入中的应用效果。方法:回顾性分析2013年10月至2014年3月行保留双侧半棘肌的改良肌间隙入路颈椎单开门椎管扩大成形治疗的30例多节段颈椎病患者的临床资料,内固定材料为Centerpiece钛板固定系统。统计对比治疗前及随访时患者的目测类比评分、日本骨科协会JOA评分(17分)、颈椎功能障碍指数、颈椎总活动度及颈椎曲度,并评估治疗后轴性疼症状的严重程度。结果与结论:患者治疗后随访12-24个月。所有患者修复过程中无脊髓损伤、脑脊液漏、感染及C5神经根麻痹等并发症发生。仅1例患者修复术后出现轴性疼痛症状,但无需口服止疼药。日本骨科协会JOA评分改善率为(76.96±17.61)%;颈椎功能障碍指数由治疗前12.29±3.82降为末次随访的8.24±2.86;末次随访时颈椎总活动度为(47.41±17.33)°,为治疗前的(93.0±4.2)%;颈椎曲度由治疗前(13.47±10.54)°变为末次随访时(12.88±8.56)°。提示保留双侧半棘肌的改良肌间隙入路应用于颈椎单开门椎管扩大成形钢板置入治疗中,可最大限度保留颈椎后方结构,有利于患者修复后早期功能锻炼,减少轴性症状发生率和颈椎曲度的丢失。
BACKGROUND： Cervical single-door laminoplasty for chronic compressive myelopathy has obtained exact effects. To reduce the occurrence of related complications, different doctors have proposed different improvement programs, and have achieved a certain effect, but the effect on postoperative complications is not very well.OBJECTIVE： To evaluate the effect of modified open-door laminoplasty with steel implantation and preservation of bilateral semispinalis. METHODS： We retrospectively analyzed the data of 30 cases of multilevel cervical spondyiotic myelopathy who underwent modified open-door laminoplasty from October 2013 to March 2014. Internal fixation material was Centerpiece titanium plate fixation system. Visual Analogue Scale score, Japanese Orthopaedic Association score（17-score method）, neck disability index, range of motion of cervical vertebra, and cervical curvature were compared before treatment and during follow-up. Axial symptom severity was assessed after treatment. RESULTS AND CONCLUSION： The patients were followed up for 12-24 months. No complications appeared during repair, including postoperative spinal cord injury, cerebrospinal fluid leakage, infection or C5 nerve root palsy. Only one patient suffered from axial pain, but there was no need for oral medication. The improvement rate of Japanese Orthopaedic Association score was（76.96±17.61）%. Neck disability index decreased from 12.29±3.82 preoperatively to 8.24±2.86 in final follow-up. Range of motion of cervical vertebra（47.41±17.33）° in final follow-up, accounting for（93.0±4.2）% of preoperative data. Cervical curvature decreased from（13.47±10.54）° preoperatively to（12.88±8.56）° in final follow-up. These findings confirm that modified open-door laminoplasty with preservation of bilateral semispinalis can reserve cervical rear structure to maximum extent, is conducive to early functional exercise after rehabilitation, and reduces the incidence of axial symptoms and loss of cervical curvature.
出处
《中国组织工程研究》
CAS
北大核心
2016年第13期1873-1879,共7页
Chinese Journal of Tissue Engineering Research
