CAJ | 학술논문

目的评价颈椎椎管成形术结合微型钛板治疗多节段颈椎病的疗效.方法采用颈椎后路单开门结合微型钛板内固定治疗多节段颈椎病患者21例,对术的和术后JOA评分、椎管矢状径、颈椎生理曲度等指标进行统计学分析.结果 21例患者均获随访,时间9 ～48个月,未见严重并发症.术后6个月CT提示铰链侧骨质愈合；末次随访根据JOA评分法进行疗效评价:优9例,良7例,可3例,差2例,末次随访JOA改善率达62.5％；颈椎管矢状径术前为(9.2±1.1)mm,术后1个月为(13.5±1.4)mm,术后1个月与术前比较差异有统计学意义(t=3.02,P＜0.01),术后各期无明显变化(P＞0.05)；颈椎曲度术前为(12.6±14.7)°,末次随访为(17.1 ±12.4)°,末次随访与术前比较差异有统计学意义(t =8.26,P＜0.01),术后6个月内颈椎曲度改变不明显(P＞0.05).结论颈椎椎管成形术结合微型钛板治疗多节段颈椎病,能够有效的扩大并维持椎管矢状径,改善颈椎生理曲度,改善脊髓神经功能.
목적 평개경추추관성형술결합미형태판치료다절단경추병적료효.방법 채용경추후로단개문결합미형태판내고정치료다절단경추병환자21례,대술적화술후JOA평분、추관시상 경、경추생리곡도등지표진행통계학분석.결과 21례환자균획수방,시간9 ～48개월,미견엄중병발증.술후6개월CT제시교련측골질유합；말차수방근거JOA평분법진행료효평개:우9례,량7례,가3례,차2례,말차수방JOA개선솔체62.5％；경추관시상경술전위(9.2±1.1)mm,술후1개월위(13.5±1.4)mm,술후1개월여술전비교차이유통계학의의(t=3.02,P＜0.01),술후각기무명현변화(P＞0.05)；경추곡도술전위(12.6±14.7)°,말차수방위(17.1 ±12.4)°,말차수방여술전비교차이유통계학의의(t =8.26,P＜0.01),술후6개월내경추곡도개변불명현(P＞0.05).결론 경추추관성형술결합미형태판치료다절단경추병,능구유효적확대병유지추관시상경,개선경추생리곡도,개선척수신경공능.
Objective To evaluate the clinical outcome of cervical laminoplasty using titanium miniplate ( AO arch) for the treatment of multisegmental cervical spondylotic myelopathy (MCSM).Methods 21 patients with MCSM were operated by cervical posterior unilateral open-door laminoplasty combined with titanium miniplate internal fixation.The JOA score,sagittal diameter of the spinal canal in the midline (SD) and cervical curvature index according to the measurement of Penning method before surgery and at postoperative follow-up intervals were measured and compared by one-way analysis of variance.Results All patients were followed up for 9 ～48 months.There were no severe adverse events.CT sean showed bony fusion at hinge side since six months after operation.According to the JOA score evaluation system,al final follow-up period,9 cases were excellent,7 good,3 ordinary and 2 cases bad.Recovery rate was 62.5 ％ at final follow-up interval.Cervical SD before surgery and in posloperative one month were (9.2 ± 1.1 )mm,(13.5 ± 1.4) mm,respectively.The difference was significant between them( t =3.02,P ＜ 0.01 ),but there was no improvement since one month postoperatively ( P ＞ 0.05 ).Cervical curvature index was ( 12.6 ± 14.7 ) ° preoperatively,it was ( 17.1 ± 12.4 ) ° at final follow-up interval,indicating that cervical curvature index made obvious progress at final follow-up interval ( t =8.26,P ＜ 0.01 ),but there was no significant change within six months postoperatively ( P ＞ 0.05 ).Conclusions Cervical laminoplasty combined with titanium miniplate can enlarge and maintain cervical SD,ameliorate cervical curvature and neurological function,and it is an ideal alternative treatment for MCSM.