CAJ | 학술논문

目的：探讨颈椎后路单开门 Centerpiece 钛板内固定椎管扩大成形术治疗多节段椎管狭窄合并脊髓型颈椎病( cervical spondylotic myelopathy，CSM )的临床疗效，为临床手术治疗颈椎病提供参考。方法选取2011年3月至2014年5月，我院骨科采用颈椎后路单开门 Centerpiece 钛板内固定椎管扩大成形术治疗多节段椎管狭窄合并 CSM 患者42例，男24例，女18例；年龄52～74岁，平均(62.5±6.8)岁。分析术前、术后日本骨科协会( Japanese orthopaedic association，JOA )评分；颈肩疼痛视觉模拟评分( visual analogue scale， VAS )；颈椎曲度以及颈椎活动度的变化。结果患者术前与术后2周、3个月的 JOA 评分分别为(7.11±1.58)分，(13.42±1.25)分和 (13.89±1.50)分，术后评分和术前比较，差异有统计学意义(P＜0.05)；术后2周、3个月的 VAS 评分分别为 (1.47±1.69)分和 (1.35±0.92)分，与术前(4.03±1.72)分比较，差异有统计学意义(P＜0.05)；术前与术后 3个月颈椎曲度分别为(28.13±4.51)°，(26.19±6.64)°；术前与术后 3个月颈椎活动度分别为(39.52±9.98)°，(35.45±13.22)°，术前与术后 3个月比较，差异无统计学意义(P＞0.05)。结论颈椎后路单开门 Centerpiece 钛板内固定椎管扩大成形术治疗多节段椎管狭窄合并 CSM 能够缓解患者颈肩部疼痛，改善多节段 CSM 患者的神经症状，较好地保持颈椎曲度和活动度，提高患者的生存质量。
목적：탐토경추후로단개문 Centerpiece 태판내고정추관확대성형술치료다절단추관협착합병척수형경추병( cervical spondylotic myelopathy，CSM )적림상료효，위림상수술치료경추병제공삼고。방법선취2011년3월지2014년5월，아원골과채용경추후로단개문 Centerpiece 태판내고정추관확대성형술치료다절단추관협착합병 CSM 환자42례，남24례，녀18례；년령52～74세，평균(62.5±6.8)세。분석술전、술후일본골과협회( Japanese orthopaedic association，JOA )평분；경견동통시각모의평분( visual analogue scale， VAS )；경추곡도이급경추활동도적변화。결과환자술전여술후2주、3개월적 JOA 평분분별위(7.11±1.58)분，(13.42±1.25)분화 (13.89±1.50)분，술후평분화술전비교，차이유통계학의의(P＜0.05)；술후2주、3개월적 VAS 평분분별위 (1.47±1.69)분화 (1.35±0.92)분，여술전(4.03±1.72)분비교，차이유통계학의의(P＜0.05)；술전여술후 3개월경추곡도분별위(28.13±4.51)°，(26.19±6.64)°；술전여술후 3개월경추활동도분별위(39.52±9.98)°，(35.45±13.22)°，술전여술후 3개월비교，차이무통계학의의(P＞0.05)。결론경추후로단개문 Centerpiece 태판내고정추관확대성형술치료다절단추관협착합병 CSM 능구완해환자경견부동통，개선다절단 CSM 환자적신경증상，교호지보지경추곡도화활동도，제고환자적생존질량。
Objective To evaluate the clinical outcomes of posterior unilateral open-door laminoplasty and Centerpiece titanium plate internal fixation in the treatment of multi-segmental spinal stenosis combined with cervical spondylotic myelopathy ( CSM ), and to provide a reference for the surgical treatment of cervical spondylosis. Methods From March 2011 to May 2014, 42 patients with multi-segmental spinal stenosis combined with CSM were treated by posterior unilateral open-door laminoplasty and Centerpiece titanium plate internal fixation. There were 24 males and 18 females, whose mean age was ( 62.5±6.8 ) years old ( range: 52-74 years ). The preoperative and postoperative Japanese Orthopedic Association ( JOA ) and Visual Analogue Scale ( VAS ) scores were analyzed, and the changes in the cervical curvature and cervical range of motion ( ROM ) were recorded.Results The JOA scores preoperatively and at 2 weeks and 3 months after the operation were ( 7.11±1.58 ) points, ( 13.42±1.25 ) points and ( 13.89±1.50 ) points respectively, and there were statistically signiifcant differences between the preoperative and postoperative scores (P<0.05 ). The VAS scores preoperatively and at 2 weeks and 3 months after the operation were ( 4.03±1.72 ) points, ( 1.47±1.69 ) points and ( 1.35±0.92 ) points respectively, and there were statistically signiifcant differences between the preoperative and postoperative scores (P<0.05 ). The cervical curvature angles preoperatively and at 3 months after the operation were ( 28.13±4.51 ) ° and ( 26.19±6.64 ) ° respectively. The cervical ROM preoperatively and at 3 months after the operation were ( 39.52±9.98 ) ° and ( 35.45±13.22 ) ° respectively, and no statistically signiifcant differences existed between them (P>0.05 ).Conclusions The clinical outcomes of posterior unilateral open-door laminoplasty and Centerpiece titanium plate internal ifxation are satisfactory in the treatment of multi-segmental spinal stenosis combined with CSM, with the advantages of relieving the neck and shoulder pain, alleviating the neurological symptoms, preserving the cervical curvature and ROM and improving the quality of life of the patients.