单开门椎板成形微钛板固定治疗脊髓型颈椎病

发布时间：2018-08-27 14:18

【摘要】：目的:探讨单开门椎板成形微钛板固定治疗脊髓型颈椎病的临床疗效。方法:回顾性分析2013年1月至2014年3月于我院接受手术治疗的脊髓型颈椎病患者49例,男37例,女12例,年龄56-71岁,平均年龄为60.2±2.6岁。将其随机分为两组,一组行颈后路单开门后以微钛板固定,为微钛板固定组;一组行颈后路单开门后以粗丝线缝合固定,为粗丝线缝合固定组。微钛板固定组为男20例,女5例,粗丝线缝合固定组为男17例,女7例。患者均在术后三个月、六个月、十二个月门诊复查,复查内容主要为询问并记录患者自身感觉,医生查体体征,常规拍摄颈椎X线、CT、MRI检查,测量椎管前后径指数,测量开门角度,(Fig.1.1-1.2)评估椎管扩大率,与术前各项指标对比,采用(JOA评分标准)评价神经功能,其最高分为17分,分值越高,表明神经功能损害越轻。结果:微钛板固定组:椎管扩大率32.6%±1.0%,平均术前JOA评分为(7.4±1.9),末次随访时为(13.2±1.8),改善率为62.3%。3例患者术后出现轴性症状,1例患者术后出现颈5神经根麻痹症状,经对症治疗后好转;所有患者末次随访时均未出现螺钉松动、微钛板移位,开门侧骨质塌陷再次压迫脊髓等并发症,无再关门现象出现。粗丝线缝合固定组:椎板减压范围:椎管扩大率29.8%±1.5%,术前平均JOA评分为(8.3±1.4),末次随访时为(12.6±1.8),改善率为52.3%。3例发生“再关门”现象,1例患者术后出现轴性症状,2例患者术后出现颈5神经根麻痹,经对症治疗后好转;无伤口延迟愈合现象。结论:颈椎后路单开门椎板成形术中使用微钛板固定,固定效果稳定,术后可防止椎板因固定不牢导致的弹性回缩,能有效维持单开门术后的开门角度,能最大限度的防止“再关门”现象的发生,防止颈椎曲度丢失,减少轴性症状,是治疗脊髓型颈椎病的有效方法。
[Abstract]:Objective: to investigate the clinical effect of single open-door laminoplasty microtitanium plate fixation for cervical Spondylotic myelopathy (Cervical Spondylotic Spondylotic myelopathy). Methods: from January 2013 to March 2014, 49 patients with cervical Spondylotic myelopathy, 37 males and 12 females, aged 56-71 years, with an average age of 60.2 卤2.6 years, were analyzed retrospectively. They were randomly divided into two groups: one group was fixed with microtitanium plate after single open door through posterior cervical approach, the other group was fixed with coarse silk suture after single open door of cervical posterior approach. There were 20 males and 5 females in the microplate fixation group, and 17 males and 7 females in the coarse silk suture group. All the patients underwent outpatient reexamination at 3 months, 6 months and 12 months after operation. The main contents of the reexamination were to inquire and record the patient's own feeling, to record the physical signs of the patients, to take routine X-ray and CT MRI examination of the cervical spine, and to measure the anterior and posterior diameter index of the spinal canal. The open door angle (Fig.1.1-1.2) was used to evaluate the spinal canal enlargement rate. Compared with the preoperative indexes, the nerve function was evaluated by using (JOA score). The highest score was 17 points, the higher the score was, the lighter the nerve function damage was. Results: in the microtitanium plate fixation group, the spinal canal enlargement rate was 32.6% 卤1.0, the average preoperative JOA score was (7.4 卤1.9), and the last follow-up was (13.2 卤1.8). The improvement rate was 62.3.3 cases with axial symptoms and 1 case with cervical 5 nerve root paralysis, which was improved after symptomatic treatment. At the last follow-up, there were no complications such as screw loosening, microtitanium plate displacement, bony collapse of the open door side and compression of the spinal cord, and no re-closing. In the coarse silk suture fixation group, the lamina decompression range: the spinal canal enlargement rate was 29.8% 卤1.5%, the mean preoperative JOA score was (8.3 卤1.4), and the last follow-up was (12.6 卤1.8). The improvement rate was 52.3.3 cases with the phenomenon of "reclosing the door" and 1 case with axonal symptoms after operation. After the onset of cervical 5 nerve root paralysis, After symptomatic treatment, there was no delayed wound healing. Conclusion: the application of microtitanium plate fixation in posterior single-door laminoplasty of cervical vertebrae can prevent the elastic retraction of lamina laminae due to the unfastness of fixation, and can effectively maintain the open door angle after single door opening. It is an effective treatment for cervical Spondylotic myelopathy to prevent the occurrence of "reclosing", to prevent the loss of cervical curvature and to reduce the axial symptoms in the treatment of cervical Spondylotic myelopathy.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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