微型钛板内固定在颈椎后路单开门术中的应用及疗效比较
The application of using micro-titanium plate fixation in unilateral single-door laminoplasty and comparison of efficacy
目的 探讨微型钛板内固定在颈椎后路单开门术中的应用，与传统方法比较，观察微型钛板应用的优缺点。 方法 2005年1月至2009年11月，205例患者实施传统方法行颈椎后路单开门术，其中53例获得完整随访，为A组；2009年12月至2012年6月，77例患者在行颈椎后路单开门术中应用微型钛板支撑内固定，65例患者获得随访，为B组。比较两组患者的术前、术后JOA( Japanese Orthopaedic Association score )评分、颈椎轴性疼痛，手术时间及出血量，并比较不同手术方法术后椎板门轴愈合率、颈椎生理弧度及活动度，观察临床效果。 结果 A、B 两组患者术前JOA评分无统计学差异，A、B 两组患者术后JOA评分、JOA评分改善率无统计学差异，但手术时间及出血量、门轴愈合率、颈椎前凸角、轴性疼痛、颈椎生理弧度、颈椎活动度统计学分析有显著性差异，B组明显优于A组。 结论 微型钛板支撑内固定在颈椎后路单开门术中的应用，有利于患者术后早期活动，提高门轴愈合率、获得更佳的颈椎活动度。
Objective To investigate the advantage and disadvantage of using micro-titanium fixation in unilateral single-door laminoplasty (USDL), and compare its efficacy to traditional surgical approach. Methods From January 2005 to November 2009, there were 205 patients received traditional USDL in our hospital. Among those, 53 patients completed follow-up and are included in the comparison study (group A). From December 2009 to June 2012, 77 patients underwent USDL with micro-titanium fixation, and 65 cases completed follow-up (group B). The patients were evaluated by the changes of JOA score and the severity of neck axial pain before and after surgery. The operation duration and blood lost were recorded. The postoperative rate of hinge union, cervical lordosis and cervical range of motion were compared between patients undergoing different surgical approach. Results The preoperative JOA score had no statistical significance between the two treatment groups. There was also no statistical significance of the postoperative JOA score and the improvement rate of JOA scoring between the two groups. However, the patients received USDL with micro-titanuim fixation had better outcomes in the operation duration, amount of blood lost, rate of hinge union, axial pain, cervical lordosis, and cervical physical range and range of motion. Conclusion The application of micro-titanium plate fixation in the USDL could improve the rate of hinge union and achieve better cervical range of motion. The technique might provide benefit to patients and enable their early postoperative rehabilitation.
[1] Hirabayashi K, Watanabe K, Wakano K, et al. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy
[J]. Spine，1983，8(7):693-699.
[2] Yu HL， Xiang LB， Liu J. Laminoplasty using Twinfix suture anchors to maintain cervical canal expansion
[J]. Eur Spine,2010,19(10):1795–1798.
[3] Garcia RM, Qureshi SA, Cassinelli EH,et al. Detection of postoperative neurologic deficits using somatosensory-evoked potentials alone during posterior cervical laminoplasty
[J]. Spine J,2010,10(10) 890-895.
[4] Morio Y, Yamamoto K, Teshima R, et al. Clinicoradiologic study of cervical laminoplasty with posterolateral fusion or bone graft
[J]. Spine,
2000,25(2):190-196.
[5] Sasai K, Saito T, Akagi S, et al. Cervical curvature after laminoplasty for spondylotic myelopathy-involvement of yellow ligament, semispinalis cervicis muscle, and nuchal ligament
[J]. Spinal Disord, 2000,13(1):26-30.
[6] Hirabayashi K, Satomi K. Operative procedure and results of expansive open-door laminoplasty
[J]. Spine, 1988,13(7): 870-876.
[7] Satomi K, Nishi Y, Kohno T, et al. Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy
[J]. Spine,1994,19(5):507-510.
[8] Minoda Y, Nakamura H, Konishi S,et al. Palsy of the C5 nerve root after midsagittal-splitting laminoplasty of the cervical spine
[J]. Spine,2003,28(11):1123-1127.
[9] 茅剑平,田伟,刘波. 保留C2和C7棘突肌肉止点的改良颈椎后路椎管扩大成型术的疗效分析
[J]. 中华医学杂志, 2010, 90(5)：337-341.
京ICP备08002354号-3/
| 〈 |
|
〉 |
