摘要
目的:探讨C_(3)椎板切除与改良Y型纳米骨板固定颈椎单开门术后颈椎活动度、曲度、神经功能及临床意义。方法:分析2015年9月至2019年9月69例因多节段脊髓型脊椎病(Multilevel cervical spondylotic myelopathy,MCSM)入院后行颈后路单开门椎管扩大成形术的患者临床资料,其中,将33例行C_(3)椎板切除、C_(4)~C_(6)或C_(4)~C_(7)改良Y型纳米骨板固定单开门椎管扩大术的患者作为A组,36例行传统C_(3)~C_(6)或C_(3)~C_(7)单开门椎管扩大成形术患者为B组。分别记录两组手术时间、术中失血量、术后引流量和住院天数。分别于术前、术后6个月、术后1年和末次随访采用X线测量颈椎活动度、C_(2)~C_(7) Cobb角,计算颈椎曲度指数(Cervical curvature index,CCI)、日本骨科协会(Modified Japanese Orthopaedic Association,mJOA)评分及对术后并发症进行评估。结果:A组的手术时间、失血量均大于B组(P<0.05),A组术后6个月、1年及末次随访的颈椎活动度(CROM)及CCI均大于B组,A组术后1年和末次随访的C_(2)~C_(7) Cobb角均大于B组(P<0.05),但A组CROM、CCI及颈椎曲度丢失值均小于B组(P<0.05);A组轴性症状的发生率低于B组(P<0.05)。两组组内术后6个月、术后1年mJOA评分逐渐上升(P<0.05)。结论:C_(3)椎板切除、C_(4)~C_(6)或C_(4)~C_(7)单开门改良Y型骨板固定椎管扩大术治疗MSCM与传统术式相比具有相同的神经功能改善率,同时保留了术后的颈椎活动度及曲度,对术后轴性症状的发生也有一定的预防作用。
Objective:To explore the effects of C_(3)laminectomy and modified Y-type nanoplate fixation on cervical spine range of motion,curvature and nerve function and its clinical significance.Methods:To analyze the clinical data of 69 patients with multilevel cervical spondylotic myelopathy(MCSM)who underwent posterior cervical single-door expansion spinal canal surgery from September 2015 to September 2019.Thirty-three patients who underwent C_(3)laminectomy,C_(4)‒C_(6) or C_(4)‒C_(7) modified Y-type nanoplate fixed single-door spinal canal enlargement were treated as group A,and 36 pa⁃tients underwent traditional C_(3)‒C_(6) or C_(3)‒C_(7) single-door expansion.Patients with dilated spinal canalplasty were treated as group B.The operation time,intraoperative blood loss,postoperative drainage and hospitalization days of the two groups were recorded respectively.X-rays were used to measure cervical spine range of motion,C_(2)‒C_(7) Cobb angle before operation,6 months after operation,1 year and last follow-up,Calculate the cervical curvature index(CCI),Modified Japa⁃nese Orthopaedic Association(mJOA)score and evaluate postoperative complications.Results:The operation time and blood loss of group A were greater than those of group B(P<0.05).The cervical spine range of motion(CROM)and CCI at 6 months,1 year and the last follow-up of group A were greater than those of group B.Group A was postoperative The C_(2)‒C_(7) Cobb angles at 1 year and the last follow-up were larger than those of group B(P<0.05),but the values of CROM,CCI,and cervical curvature loss in group A were lower than those of group B(P<0.05);the incidence of axial symptoms in group A was lower than that of group B(P<0.05).The mJOA scores increased gradually in the two groups at 6 months after surgery and 1 year after surgery(P<0.05).Conclusion:C_(3)laminectomy,C_(4)‒C_(6) or C_(4)‒C_(7) single door modified Y-plate fixation spinal canal enlargement surgery for MSCM has the same neurological improvement rate com⁃pared with traditional surgery,while retaining the postoperative cervical spine mobility,and the curvature can also pre⁃vent the occurrence of postoperative axial symptoms.
作者
刘通
周育巧
许强
赖仲宏
陈宇
朱文清
赖金良
陈金财
姬广林
LIU Tong;ZHOU Yu-qiao;XU Qiang;LAI Zhong-hong;CHEN Yu;ZHU Wen-qing;LAI Jin-liang;CHEN Jin-cai;JI Guang-lin(Postgraduate students of Grade 2019,Gannan Medical University,Ganzhou,Jiangxi 341000;Postgraduate student of Grade 2018,Gannan Medical University,Ganzhou,Jiangxi 341000;Department of Orthopedics,the First Affiliated Hospital of Gannan Medical University,Ganzhou,Jiangxi 341000)
出处
《赣南医学院学报》
2021年第9期918-923,共6页
JOURNAL OF GANNAN MEDICAL UNIVERSITY
基金
赣南医学院2020年度校级科技创新特色建设团队课题(TS202002)。
关键词
多节段脊髓型颈椎病
椎板切除
纳米骨板
单开门椎管扩大成形术
颈椎曲度
颈椎活动度
Multi-segment cervical spondylotic myelopathy
Laminectomy
Nano bone plate
Single-door spinal canal enlargement
Cervical curvature
Cervical spine range of motion
