CAJ | 학술논문

目的回顾性分析颈椎单开门OsteoMed M3钉板内固定椎管扩大成形术后的治疗效果及影响因素.方法选择多节段椎间盘突出并椎管狭窄等颈椎疾病患者26例,行颈椎单开门OsteoMed M3钉板内固定椎管扩大成形手术治疗,术后随访1年以上,应用JOA评分法对术前及术后的脊髓功能改善情况进行对比及评价.对影响术后疗效的相关因素进行分析.结果 26例患者术后随访1年以上,术前JOA评分:9.40±1.658(5～13分)分,术后JOA评分:13.80±1.958(7～ 16分)分,差异有统计学意义(t=- 21.137,P=0.000),大部分患者症状明显改善,术后改善率为57.9％.术后X线片、MRI及CT检查提示椎管的矢状径和椎管均明显扩大,3例症状改善不明显的患者,2例二期实施前路减压固定融合术后症状缓解,1例后纵韧带骨化症患者恢复欠佳；无一例出现继发性椎管狭窄引起神经功能变坏或手术相关的并发症.年龄大、病史时间长、病情重、术前合并颈椎后凸畸形及病变部位脊髓MRI信号改变会影响患者的恢复,术后早期行功能锻炼有利于患者的恢复.结论在颈椎单开门椎管扩大成形术中应用OsteoMed M3钉板内固定具有避免开门后再关闭,保持椎管扩大效果,且操作简单,并发症少,费用低廉,适合临床运用.
목적 회고성분석경추단개문OsteoMed M3정판내고정추관확대성형술후적치료효과급영향인소.방법 선택다절단추간반돌출병추관협착등경추질병환자26례,행경추단개문OsteoMed M3정판내고정추관확대성형수술치료,술후수방1년이상,응용JOA평분법대술전급술후적척수공능개선정황진행대비급평개.대영향술후료효적상관인소진행분석.결과 26례환자술후수방1년이상,술전JOA평분:9.40±1.658(5～13분)분,술후JOA평분:13.80±1.958(7～ 16분)분,차이유통계학의의(t=- 21.137,P=0.000),대부분환자증상명현개선,술후개선솔위57.9％.술후X선편、MRI급CT검사제시추관적시상경화추관균명현확대,3례증상개선불명현적환자,2례이기실시전로감압고정융합술후증상완해,1례후종인대골화증환자회복흠가；무일례출현계발성추관협착인기신경공능변배혹수술상관적병발증.년령대、병사시간장、병정중、술전합병경추후철기형급병변부위척수MRI신호개변회영향환자적회복,술후조기행공능단련유리우환자적회복.결론 재경추단개문추관확대성형술중응용OsteoMed M3정판내고정구유피면개문후재관폐,보지추관확대효과,차조작간단,병발증소,비용저렴,괄합림상운용.
Objective To retrospectively describe the technique and review the surgical results of OsteoMed M3 titanium plate and screws used to secure the posterior elements in the open position after expansive unilateral opendoor laminoplasty.Methods Twenty-six patients with multilevel cervical disc herniation and canal stenosis were treated with an expansive unilateral open-door laminoplasty with OsteoMed M3 plate and screws.The follow-up period was over 1 year.The improvement of spinal function after surgeries under JOA was evaluated to analyse the effects and releated factors.Results All of 26 cases' follow-up period was over 1 year.The mean JOA score increased significantly from 9.40 ± 1.658 ( range,5 to 13 ) points before surgery to 13.80 ± 1.958 ( range,7 to 16) points at final follow- up ( t =- 21.137,P =0.000 ).Mean recovery rate was 57.9％.Postoperative radiography,magnetic resonance imaging and computed tomography scan demonstrated significantly increased sagittal diameter and canal expansion.Two cases without relief of nurological symptoms underwent an additional anterior multilevel corpectomy.One case with ossification of the posterior longitudinal ligament had not good enough neurologic improvement after surgery.No neurologic deterioration owing to hinge reclosure or major surgery-related complications were observed.It would reduce the recovery for those with old age,long history,worse symptoms,cervical kyphosis and abnormal signal in MR imaging.It was good for patients to do early active cervical exercises after surgery.Conclusion Unilateral open- door laminoplasty with OsteoMed M3 titanium plate and screws fixation effectively maintains expansion of the spinal canal and resists closure while preserving alignment and stability.This modified technique is easy to perform with a low complication,is and economic,and is good for clinical application.