颈后路单开门椎管成形微型钛板内固定术治疗多节段脊髓型颈椎病的早期临床疗效观察
发布时间：2018-08-12 15:42
【摘要】：目的:探讨颈后路单开门椎管成形微型钛板内固定术治疗多节段脊髓型颈椎病的早期临床疗效,为进一步临床应用提供参考和依据。方法:回顾性分析2016年02月~2016年09月于山东省中医院脊柱骨科采用颈后路单开门椎管成形微型钛板内固定术治疗的多节段脊髓型颈椎病病例,依据纳入及排除标准,共分析记录患者19例,其中男13例,女6例,年龄33~75岁,平均年龄55岁。以定期门诊复查、电话询问等方式在患者出院后进行随访,随访时间6~13个月,平均9个月。详细记录19例患者术前、术后3个月、术后6个月及末次随访的JOA评分;术后3个月、术后6个月与末次随访的轴性症状;术前、术后3个月与术后6个月颈椎侧位X线平片上椎管矢状径、颈椎曲度及SVA值;术后1周、术后6个月颈椎CT上椎板开门角度;术后6个月门轴侧骨性融合状况等资料,运用SPSS19.0统计学软件对数据分析,以P0.05为差异具有统计学意义。结果:所有19例患者均获完整随访,随访时间6~13个月,平均9个月。对数据统计分析后发现:术后3个月、术后6个月及末次随访的JOA评分较术前均明显增高,术前与术后3个月JOA及术后6个月JOA评分差异均有统计学意义(P0.05),术后3个月与术后末次随访JOA评分差异无统计学意义(P=0.1870.05);术后3个月轴性症状发生率21%,术后6个月轴性症状发生率15%,末次随访轴性症状发生率10%,术后轴性症状逐步改善;术后3个月及术后6个月椎管矢状径较术前均明显扩大,术前椎管矢状径9.50±0.48mm,术后3个月椎管矢状径16.66±0.55mm,术后6个月椎管矢状径16.58±0.50mm,患者术前与术后3个月椎管矢状径差异有统计学意义(p=0.0030.05),术后3个月及术后6个月椎管椎管矢状径差异无统计学意义(p=0.130.05);术后SVA及颈椎曲度较术前变化不明显;术前SVA为26.21±2.49mm,术后3个月SVA为26.89±2.26mm,术后6个月SVA为27.16±2.41mm,患者术前与术后3个月SVA数值差异无统计学意义(p=0.1140.05),患者术后3个月与术后6个月SVA数值差异无统计学意义(p=0.5560.05);术前颈椎曲度15±4.07°,术后3个月颈椎曲度14.26±3.46°,术后6个月颈椎曲度13.84±2.83°,术前与术后3个月颈椎曲度差异无统计学意义(p=0.1670.05),术后3个月及术后6个月颈椎曲度差异无统计学意义(p=0.4690.05);术后1周与术后6个月椎板开门角度变化不明显,术后1周开门角度35.35±4.26°,术后6个月开门角度35.92±3.68°,差异无统计学意义(p0.05);术后6个月骨性融合率85%;术后椎动脉损伤1例,未见C5神经根麻痹及再关门现象等其他并发症。结论:对颈后路单开门椎管成形微型钛板内固定术治疗多节段脊髓型颈椎病早期临床疗效分析后发现,该术式有以下优点:1.能有效扩大椎管矢状径并维持椎管矢状径和椎板开门角度的稳定、有效改善神经症状。2.对矢状位平衡和颈椎生理曲度影响小。3.骨性融合率高。4.轴性症状发生率低且逐步缓解,其他并发症少。颈后路单开门椎管成形微型钛板内固定术为治疗多节段脊髓型颈椎病安全、有效方法。
[Abstract]:Objective: To investigate the early clinical effect of posterior cervical open-door laminoplasty and mini-titanium plate internal fixation in the treatment of multilevel cervical spondylotic myelopathy, and to provide reference and basis for further clinical application. According to the inclusion and exclusion criteria, 19 patients with multilevel cervical spondylotic myelopathy were analyzed and recorded, including 13 males and 6 females, aged 33-75 years, with an average age of 55 years. JOA score at preoperative, postoperative 3 months, 6 months and final follow-up; axial symptoms at 3 months, 6 months and final follow-up; sagittal diameter, cervical curvature and SVA on lateral cervical X-ray plain film at preoperative, 3 months and 6 months postoperatively; upper cervical vertebral lamina open angle at 1 week and 6 months postoperatively; portal axial bone at 6 months postoperatively Results: All 19 patients were followed up for 6-13 months, with an average of 9 months. The JOA scores of 3 months, 6 months and the last follow-up were significantly higher than those of preoperative. There was no significant difference in JOA score between preoperative and postoperative 3 months and 6 months (P = 0.1870.05). The incidence of axial symptoms was 21% at 3 months, 15% at 6 months, 10% at the last follow-up, and 10% at the last follow-up. The sagittal diameter of the spinal canal was significantly enlarged at 3 months and 6 months after operation. The sagittal diameter of the spinal canal was 9.50 (+ 0.48 mm) before operation, 16.66 (+ 0.55 mm) at 3 months after operation, and 16.58 (+ 0.50 mm) at 6 months after operation. The sagittal diameter of the spinal canal was significantly different from that at 3 months after operation (p = 0.0030.05). There was no significant difference in sagittal diameter of spinal canal 6 months after operation (p = 0.130.05); there was no significant difference in SVA and cervical curvature after operation; preoperative SVA was 26.21 (+ 2.49 mm), postoperative SVA was 26.89 (+ 2.26 mm) at 3 months, and postoperative SVA was 27.16 (+ 2.41 mm) at 6 months. There was no significant difference in SVA between preoperative and postoperative 3 months (p = 0.1140.05). There was no significant difference in SVA between 3 months and 6 months after operation (p = 0.5560.05); cervical curvature before operation was 15 [4.07], 3 months after operation was 14.26 [3.46], and 6 months after operation was 13.84 [2.83]. There was no significant difference in cervical curvature before operation and 3 months after operation (p = 0.1670.05). There was no significant difference in the opening angle of vertebral lamina between 1 week and 6 months after operation (p = 0.4690.05). The opening angle of vertebral lamina at 1 week and 6 months after operation was 35.35 [4.26], and that at 6 months after operation was 35.92 [3.68], with no significant difference (p 0.05); the rate of bone fusion at 6 months after operation was 85%; 1 case of vertebral artery injury, no C5 nerve root paralysis and re-closure were found. Conclusion: After analyzing the early clinical effect of posterior cervical open-door laminoplasty and mini-titanium plate fixation in the treatment of multi-level cervical spondylotic myelopathy, we found that this method has the following advantages: 1. It can effectively enlarge the sagittal diameter of the spinal canal, maintain the sagittal diameter of the spinal canal and the stability of the angle of opening the lamina, and effectively improve the neurological symptoms. The incidence of axial symptoms was low and gradually alleviated, and other complications were few. Posterior cervical open-door laminoplasty with mini-titanium plate internal fixation was a safe and effective method for the treatment of multilevel cervical spondylotic myelopathy.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
本文编号：2179513
[Abstract]:Objective: To investigate the early clinical effect of posterior cervical open-door laminoplasty and mini-titanium plate internal fixation in the treatment of multilevel cervical spondylotic myelopathy, and to provide reference and basis for further clinical application. According to the inclusion and exclusion criteria, 19 patients with multilevel cervical spondylotic myelopathy were analyzed and recorded, including 13 males and 6 females, aged 33-75 years, with an average age of 55 years. JOA score at preoperative, postoperative 3 months, 6 months and final follow-up; axial symptoms at 3 months, 6 months and final follow-up; sagittal diameter, cervical curvature and SVA on lateral cervical X-ray plain film at preoperative, 3 months and 6 months postoperatively; upper cervical vertebral lamina open angle at 1 week and 6 months postoperatively; portal axial bone at 6 months postoperatively Results: All 19 patients were followed up for 6-13 months, with an average of 9 months. The JOA scores of 3 months, 6 months and the last follow-up were significantly higher than those of preoperative. There was no significant difference in JOA score between preoperative and postoperative 3 months and 6 months (P = 0.1870.05). The incidence of axial symptoms was 21% at 3 months, 15% at 6 months, 10% at the last follow-up, and 10% at the last follow-up. The sagittal diameter of the spinal canal was significantly enlarged at 3 months and 6 months after operation. The sagittal diameter of the spinal canal was 9.50 (+ 0.48 mm) before operation, 16.66 (+ 0.55 mm) at 3 months after operation, and 16.58 (+ 0.50 mm) at 6 months after operation. The sagittal diameter of the spinal canal was significantly different from that at 3 months after operation (p = 0.0030.05). There was no significant difference in sagittal diameter of spinal canal 6 months after operation (p = 0.130.05); there was no significant difference in SVA and cervical curvature after operation; preoperative SVA was 26.21 (+ 2.49 mm), postoperative SVA was 26.89 (+ 2.26 mm) at 3 months, and postoperative SVA was 27.16 (+ 2.41 mm) at 6 months. There was no significant difference in SVA between preoperative and postoperative 3 months (p = 0.1140.05). There was no significant difference in SVA between 3 months and 6 months after operation (p = 0.5560.05); cervical curvature before operation was 15 [4.07], 3 months after operation was 14.26 [3.46], and 6 months after operation was 13.84 [2.83]. There was no significant difference in cervical curvature before operation and 3 months after operation (p = 0.1670.05). There was no significant difference in the opening angle of vertebral lamina between 1 week and 6 months after operation (p = 0.4690.05). The opening angle of vertebral lamina at 1 week and 6 months after operation was 35.35 [4.26], and that at 6 months after operation was 35.92 [3.68], with no significant difference (p 0.05); the rate of bone fusion at 6 months after operation was 85%; 1 case of vertebral artery injury, no C5 nerve root paralysis and re-closure were found. Conclusion: After analyzing the early clinical effect of posterior cervical open-door laminoplasty and mini-titanium plate fixation in the treatment of multi-level cervical spondylotic myelopathy, we found that this method has the following advantages: 1. It can effectively enlarge the sagittal diameter of the spinal canal, maintain the sagittal diameter of the spinal canal and the stability of the angle of opening the lamina, and effectively improve the neurological symptoms. The incidence of axial symptoms was low and gradually alleviated, and other complications were few. Posterior cervical open-door laminoplasty with mini-titanium plate internal fixation was a safe and effective method for the treatment of multilevel cervical spondylotic myelopathy.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
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