CAJ | 학술논문

目的：评估颈椎后路单开门微型钛板固定椎板成形术治疗多节段颈椎病的临床应用价值。方法回顾性分析2011年1月至2012年9月在我科行颈椎后路单开门微型钛板固定椎板成形术的多节段脊髓型颈椎病患者43例，记录手术时间、术中出血量、JOA评分改善率、术后轴性症状发生率及严重程度；同时在随访的影像资料上测量术后脊髓后移距离、颈椎曲度指数改变及丢失程度、术后椎管扩大率及椎板开门角度。结果平均手术时间(107.1±16.3) min，术中平均出血量(200.0±28.7) ml，椎板开门角度为(48.0±3.1)°。术后椎管扩大率为(69.7±13.5)%；颈椎曲度指数较术前明显减少(P<0.01)，丢失程度为(3.4±2.7)%；平均脊髓后移距离为(3.1±0.7) mm；术后JOA评分较术前明显增加(P<0.01)。JOA评分改善率与脊髓后移距离无明显相关性(r=0.161，P=0.301)。结论颈椎后路单开门微型钛板固定椎板成形术治疗多节段颈椎病操作简单，安全可靠，可避免开门后再关门；并可获得手术后即刻的稳定性，减少术后颈椎曲度的丢失和后凸畸形的发生率，术后神经功能恢复明显，是一种治疗多节段颈椎病的有效方法。
목적：평고경추후로단개문미형태판고정추판성형술치료다절단경추병적림상응용개치。방법회고성분석2011년1월지2012년9월재아과행경추후로단개문미형태판고정추판성형술적다절단척수형경추병환자43례，기록수술시간、술중출혈량、JOA평분개선솔、술후축성증상발생솔급엄중정도；동시재수방적영상자료상측량술후척수후이거리、경추곡도지수개변급주실정도、술후추관확대솔급추판개문각도。결과평균수술시간(107.1±16.3) min，술중평균출혈량(200.0±28.7) ml，추판개문각도위(48.0±3.1)°。술후추관확대솔위(69.7±13.5)%；경추곡도지수교술전명현감소(P<0.01)，주실정도위(3.4±2.7)%；평균척수후이거리위(3.1±0.7) mm；술후JOA평분교술전명현증가(P<0.01)。JOA평분개선솔여척수후이거리무명현상관성(r=0.161，P=0.301)。결론경추후로단개문미형태판고정추판성형술치료다절단경추병조작간단，안전가고，가피면개문후재관문；병가획득수술후즉각적은정성，감소술후경추곡도적주실화후철기형적발생솔，술후신경공능회복명현，시일충치료다절단경추병적유효방법。
Objective To evaluate the clinical application of unilateral open-door cervical expansive lamino-plasty plus titanium miniplate fixation for multilevel cervical spondylotic myelopathy. Methods From January 2011 to September 2012, 43 patients of multilevel cervical spondylotic myelopathy treated with unilateral open-door cervi-cal expansive laminoplasty plus titanium miniplate fixation were enrolled retrospectively in this study. The operation time, blood loss, Japanese Orthopaedic Association (JOA) scores and incidence of axial symptoms were recorded re-spectively. The imaging materials of clinical follow-up were used to measure and evaluate the posterior shifting of spi-nal cord, loss of cervical curvature, expansion rate of spinal canal and angle of the opened laminae. Results The av-erage time of the operation was (107.1 ± 16.3) min. The mean blood loss was (200.0 ± 28.7) ml. The angle of opened laminae was 48.0°±3.1°. The postoperative expansion rate of spinal canal was (69.7±13.5)%. The cervical curvature in-dex decreased significantly compared with preoperative cervical curvature index (P<0.01). The loss of cervical curva-ture was (3.4 ± 2.7)%. The postoperative JOA scores increased obviously compared with the preoperative JOA scores (P<0.01). The mean posterior shifting of spinal cord was (3.1 ± 0.7) mm. The improvement rates of JOA score have nothing to do with the posterior shifting of spinal cord (r=0.161,P=0.301). Conclusion The unilateral open-door cer-vical expansive laminoplasty via titanium miniplate is safe and efficacious in the treatment of multilevel CSM, which can reduce the loss of cervical curvature and incidence rate of kyphosis, prevent reclose of opened laminae. Moreover, The postoperative neural function recovered obviously.