单开门颈椎管扩大成形Centerpiece钛板内固定术治疗脊髓型颈椎病的中期临床疗效

发布时间：2019-03-19 21:32

【摘要】：目的:探讨单开门颈椎管扩大成形Centerpiece钛板内固定术治疗脊髓型颈椎病的中期临床疗效。方法:选择2009年1月~2011年6月在我院行后路椎管扩大成形Centerpiece钛板内固定术治疗的脊髓型颈椎病患者59例,其中男性42例,女性17例,年龄21~68岁,平均56.2±9.8岁。MRI显示3个节段狭窄12例,4个节段狭窄29例,5个节段狭窄18例。以日本骨科协会(JOA)评分(17分法)及其改善率评价术后神经功能改善情况;视觉模拟评分(visual analogue scale/score,VAS)及颈部功能障碍指数(neck dysfunction index,NDI)评价患者的疼痛及功能变化情况;术后复查颈椎X线、CT及MRI,在术前及末次随访时的颈椎X线片上测量C2~C7夹角、颈椎活动度(ROM),在颈椎三维CT上测量椎管矢状径及椎管横截面积,计算椎管扩大率[(术后椎管矢状径-术前椎管矢状径)/(术前椎管矢状径)×100%],评价椎管扩大和维持情况及门轴侧骨融合情况。结果:手术时间为142.2±18.1min,术中出血量为264.5±50.5ml,术后引流量为252.3±28.6ml,住院日为7.2±0.7d。在术后随访过程中,15例出现了颈后部轴性疼痛症状,按照VAS评分,13例为轻度疼痛,2例为中度疼痛,所有患者颈部轴性疼痛症状均于术后1年内消失。1例术后第3天出现C5神经根麻痹症状,经2周保守治疗症状明显缓解,于术后12周时症状完全消失。随访48~72个月,平均60.5±2.7个月,术前JOA评分为8.5±0.5分,末次随访为15.4±1.3分,改善率为(77.1±5.2)%。术前平均VAS评分为3.9±0.4分,末次随访时为1.3±0.6分。术前平均NDI为20.3±5.4,末次随访时为6.5±1.8。影像学复查示术后随访期间颈椎管扩大满意,脊髓受压完全解除,椎管矢状径平均值术前为9.7±0.9mm,末次随访时为16.8±1.2mm,椎管扩大率为(67.6±13.9)%,椎管矢状面积术前为128.1±13.5mm~2,末次随访时为318.3±34.3mm2。末次随访时颈椎ROM值较术前减少9.6°±2.4°,手术前与术后随访期间C2~C7夹角未见明显差异(P0.05)。术后6个月门轴侧均达骨性愈合,随访期间均未出现关门及神经损害症状加重的情况。结论:单开门颈椎管扩大成形Centerpiece钛板内固定术是治疗脊髓型颈椎病的一种简便、安全的方法,中期临床疗效较满意。
[Abstract]:Objective: to investigate the mid-term clinical effect of Centerpiece titanium plate fixation in the treatment of cervical Spondylotic myelopathy (CSM). Methods: from January 2009 to June 2011, 59 patients with cervical Spondylotic myelopathy, including 42 males and 17 females, aged 21 ~ 68 years, were treated with Centerpiece titanium plate fixation. The mean age was 56.2 卤9.8 years. MRI showed 3 segments stenosis in 12 cases, 4 segments in 29 cases, 5 segments in 18 cases. The improvement of neurologic function was evaluated by (JOA) score (17 points) and improvement rate of Japanese Orthopaedics Association (JOA). Visual analogue score (visual analogue scale/score,VAS) and cervical dysfunction index (neck dysfunction index,NDI) were used to evaluate the pain and functional changes of the patients. The cervical X-ray, CT and MRI, were used to measure the C2~C7 angle before and after the last follow-up. The sagittal diameter and cross-sectional area of the vertebral canal were measured by (ROM), on the 3D CT of the cervical spine, and the angle of the cervical spine was measured on the cervical X-ray before and after the last follow-up. The enlargement rate [(sagittal diameter of vertebral canal before operation) / (sagittal diameter of spinal canal before operation) 脳 100%] was calculated, and the enlargement and maintenance of spinal canal and the fusion of portal axis were evaluated. Results: the operative time was 142.2 卤18.1min, the intraoperative bleeding was 264.5 卤50.5ml, the postoperative drainage was 252.3 卤28.6ml, and the hospitalization day was 7.2 卤0.7d. During the follow-up, 15 cases had symptoms of posterior cervical axial pain. According to VAS score, 13 cases had mild pain and 2 cases had moderate pain. The symptoms of cervical axial pain disappeared within 1 year after operation in all patients, and the symptoms of C5 nerve root paralysis appeared in 1 case on the 3rd day after operation, relieved obviously after 2 weeks of conservative treatment, and completely disappeared at 12 weeks after operation. The mean follow-up period was 60.5 卤2.7months. The preoperative JOA score was 8.5 卤0.5points, and the last follow-up was 15.4 卤1.3.The improvement rate was (77.1 卤5.2)%. The mean VAS score was 3. 9 卤0. 4 before operation and 1. 3 卤0. 6 at the last follow-up. The mean NDI was 20.3 卤5.4 before operation and 6.5 卤1.8 at the last follow-up. The average sagittal diameter of vertebral canal was 9.7 卤0.9 mm before operation, 16.8 卤1.2 mm at last follow-up, and the enlargement rate of spinal canal was (67.6 卤13.9)%. The sagittal area of spinal canal before operation was 128.1 卤13.5 mm~2, at the last follow-up of 318.3 卤34.3mm 2. At the last follow-up, the ROM value of cervical spine decreased by 9.6 掳卤2.4 掳compared with that before operation. There was no significant difference in C2~C7 angle between pre-and post-operative follow-up (P0.05). At 6 months after operation, osseous healing was achieved on the axonal side of the portal, and there was no sign of closing and aggravation of nerve damage during the follow-up period. Conclusion: Centerpiece titanium plate fixation is a simple and safe method for the treatment of cervical Spondylotic myelopathy, and the clinical effect is satisfactory in the middle stage of cervical Spondylotic myelopathy.
【作者单位】：第四军医大学西京医院骨科;南方医科大学深圳医院骨科中心;
【基金】：国家自然科学基金面上项目(81270959)
【分类号】：R687.32

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