CAJ | 학술논문

目的：探讨颈后路单开门椎管扩大成形术、椎弓根螺钉个体化置钉内固定术治疗柔韧型颈椎后凸畸形多节段脊髓型颈椎病的临床疗效。方法2008年3月至2011年7月对21例柔韧型颈椎后凸畸形的多节段脊髓型颈椎病患者，术前均采用日本骨科协会（ JOA）评分系统判定神经功能，颈椎功能残障指数量表（NDI）评价颈肩轴性疼痛，Borden法测量颈椎曲度，CT经椎弓根水平及轴线矢状位二维成像，个体化设计螺钉的进钉点和方向，行颈后路单开门椎管扩大成形术、椎弓根螺钉个体化置钉内固定手术治疗。结果共置入椎弓根螺钉168枚，准确率93.5％（157/168），Borden法颈椎曲度术后（术后1周为6.7±2.47和末次随访6.6±2.8）与术前（-14.7±6.8）差异有统计学意义（均P＜0.05），JOA及NDI评分术后1周为（12.4±2.5）和（14.2±5.6）分、末次随访为（14.3±4.7）和（11.3±4.7）分，均高于术前的（9.4±3.5）和（18.7±9.2）分（F值分别为5.26和5.61，均P＜0.01）。结论颈后路单开门椎管扩大成形术、椎弓根螺钉内固定术可恢复颈椎生理前凸和重建颈椎的稳定性，有效改善神经症状，降低颈肩部轴性疼痛发生率。
목적：탐토경후로단개문추관확대성형술、추궁근라정개체화치정내고정술치료유인형경추후철기형다절단척수형경추병적림상료효。방법2008년3월지2011년7월대21례유인형경추후철기형적다절단척수형경추병환자，술전균채용일본골과협회（ JOA）평분계통판정신경공능，경추공능잔장지수량표（NDI）평개경견축성동통，Borden법측량경추곡도，CT경추궁근수평급축선시상위이유성상，개체화설계라정적진정점화방향，행경후로단개문추관확대성형술、추궁근라정개체화치정내고정수술치료。결과공치입추궁근라정168매，준학솔93.5％（157/168），Borden법경추곡도술후（술후1주위6.7±2.47화말차수방6.6±2.8）여술전（-14.7±6.8）차이유통계학의의（균P＜0.05），JOA급NDI평분술후1주위（12.4±2.5）화（14.2±5.6）분、말차수방위（14.3±4.7）화（11.3±4.7）분，균고우술전적（9.4±3.5）화（18.7±9.2）분（F치분별위5.26화5.61，균P＜0.01）。결론경후로단개문추관확대성형술、추궁근라정내고정술가회복경추생리전철화중건경추적은정성，유효개선신경증상，강저경견부축성동통발생솔。
Objective To evaluate the efficacy of unilateral open door laminoplasty and individualized cervical pedicle screw fixation for multisegmental cervical spondylotic myelopathy with flexibility type kyphosis.Methods Twenty one cases of multisegmental cervical spondylotic myelopathy with flexibility type kyphosis received surgical treatment.Unilateral open door laminoplasty and individualized cervical pedicle screw fixation.The Japanese Orthopaedic Association ( JOA) scoring system and disability index ( NDI) were applied to evaluate the neurological function and axial neck /shoulder pain before and after surgery.The Borden′method was employed to measure the cervical curvature.CT plain scan of cervical pedicle and sagittal two-dimensional imaging of transpedicular on the axial was examined.The unilateral open door laminoplasty and individualized cervical pedicle screw fixation was performed .Results A total of 168 pedicle screws were fixed successfully in 21 patients, the accuracy of screw placement reached 93.5%.The cervical curvature measured by Borden′method showed significant differences before and after operation.Compare to those before surgery , the JOA scores at 1 week after operation and at final follow-up were decreased and NDI scores were significant increased ( P <0.05 ).Conclusion Unilateral open door laminoplasty and individualized cervical pedicle screw fixation is effective for treatment of multisegmental cervical spondylotic myelopathy with flexibility type kyphosis.