椎板开门角度对微型钛板固定术治疗多节段脊髓型颈椎病的影响
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摘要
为了揭示椎板开门角度对颈椎单开门微型钛板固定成形术治疗多节段脊髓型颈椎病的影响,本研究根据椎板开门角度将多节段脊髓型颈椎病患者分为A组(28°~47.5°, 49例)和B组(47.5°~67°, 43例),比较两组患者颈椎单开门微型钛板固定成形术治疗后的手术时间、术中出血量、C5神经根麻痹、神经功能(JOA评分)、颈椎轴性症状和颈椎曲度。研究显示,两组患者的手术时间、术中出血量和C5神经根麻痹情况均无统计学差异(p>0.05)。两组术后的JOA评分均较术前显著升高(p<0.05),但两组术后比较差异不显著(p>0.05)。A组患者的颈椎轴性症状发生率(14.29%)显著低于B组(20.93%)(Z=-1.967, p=0.049)。A组和B组患者术后的颈椎曲度指数分别丢失了1.04%和3.88%,B组术后显著低于A组(p<0.05)。在多节段脊髓型颈椎病患者应用颈椎单开门微型钛板固定成形术治疗过程中,椎板开门角度不影响患者术后的神经功能,但开门角度过大容易造成颈椎曲度丢失程度增加,并增加轴性症状的发生率。
In order to reveal the effect of lamina opening angle on the treatment of multilevel cervical spondylotic myelopathy with cervical single-door mini-titanium plate fixation, this study divided the patients with multilevel cervical spondylotic myelopathy into group A(28°~47.5°, 49 cases) and group B(47.5°~67°, 43 cases) according to the angle of laminectomy. The operation time, intraoperative blood loss, C5 nerve root paralysis, neurological function(JOA score), cervical axial symptoms and cervical curvature after treatment with cervical single-door mini-titanium plate fixation were compared between the two groups. The study showed that there was no significant difference in the operation time, intraoperative blood loss and C5 nerve root palsy between the two groups(p>0.05). The JOA scores of the two groups were significantly higher than those before surgery(p<0.05),but the difference between the two groups after surgery was not significant(p>0.05). The incidence of cervical axial symptoms in group A(14.29%) was significantly lower than that in group B(20.93%)(Z=-1.967, p=0.049).The cervical curvature index of group A and group B lost 1.04% and 3.88% respectively. The curvature index of group B was significantly lower than that of group A(p<0.05). In the treatment of multilevel cervical spondylotic myelopathy patients with cervical single-door mini-titanium plate fixation, the lamina opening angle does not affect the patient's postoperative neurological function; however, too large opening angle can easily increase the loss of cervical curvature and increase the incidence of axial symptoms.
In order to reveal the effect of lamina opening angle on the treatment of multilevel cervical spondylotic myelopathy with cervical single-door mini-titanium plate fixation, this study divided the patients with multilevel cervical spondylotic myelopathy into group A(28°~47.5°, 49 cases) and group B(47.5°~67°, 43 cases) according to the angle of laminectomy. The operation time, intraoperative blood loss, C5 nerve root paralysis, neurological function(JOA score), cervical axial symptoms and cervical curvature after treatment with cervical single-door mini-titanium plate fixation were compared between the two groups. The study showed that there was no significant difference in the operation time, intraoperative blood loss and C5 nerve root palsy between the two groups(p>0.05). The JOA scores of the two groups were significantly higher than those before surgery(p<0.05),but the difference between the two groups after surgery was not significant(p>0.05). The incidence of cervical axial symptoms in group A(14.29%) was significantly lower than that in group B(20.93%)(Z=-1.967, p=0.049).The cervical curvature index of group A and group B lost 1.04% and 3.88% respectively. The curvature index of group B was significantly lower than that of group A(p<0.05). In the treatment of multilevel cervical spondylotic myelopathy patients with cervical single-door mini-titanium plate fixation, the lamina opening angle does not affect the patient's postoperative neurological function; however, too large opening angle can easily increase the loss of cervical curvature and increase the incidence of axial symptoms.
引文
Cai W.T.,Shen N.J.,and Lin M.X.,2014,Clinical application of unilateral open-door cervical expansive laminoplasty plus titanium miniplate fixation for multilevel cervical spondylotic myelopathy,Hainan Yixue(Hainan Medical Journal),25(11):1594-1596(蔡文涛,沈宁江,林明侠,2014,颈椎后路单开门微型钛板固定成形术治疗多节段颈椎病43例疗效观察,海南医学,25(11):1594-1596)
Grabher P.,Mohammadi S.,David G.,and Freund P.,2017,Neurodegeneration in the spinal ventral horn prior to motor impairment in cervical spondylotic myelopathy,Journal of Neurotrauma,34(15):2329-2334
Ishihara A.,1968,Roentgenographic studies on the mobility of the cervical column in the sagittal plane,Nihon Seikeigeka Gakkai Zasshi,42(11):1045-1056
Jutzeler C.,Ulrich A.,Huber B.,Rosner J.,Kramer J.L.K.,and Curt A.,2017,Improved diagnosis of cervical spondylotic myelopathy with contact heat evoked potentials,Journal of Neurotrauma,34(12):2045-2053
Wang H.,Ding W.Y.,Shen Y.,Zhang Y.Z.,Zhang W.,Yang D.L.,Sun Y.P.,Wang L.F.,Cao L.Z.,and Ma L.,2012,Analysis of axial symptoms after indirect decompression for ossification of the posterior longitudinal ligament of the cervical spine,Zhonghua Waike Zazhi(Chinese Journal of Surgery),50(7):601-606(王辉,丁文元,申勇,张英泽,张为,杨大龙,孙亚澎,王林峰,曹来震,马雷,2012,颈椎后纵韧带骨化症间接减压术后轴性症状分析,中华外科杂志,50(7):601-606)
Yang S.C.,Niu C.C.,Chen W.J.,Wu C.H.,and Yu S.W.,2008,Open-door laminoplasty for multilevel cervical spondylotic myelopathy:good outcome in 12 patients using suture anchor fixation,Acta Orthopaedica,79(1):62-66
Zeng Y.,Dang G.D.,and Ma Q.J.,2004,Evaluation of neck moving ability after anterior cervical fusion,Zhonghua Waike Zazhi(Chinese Journal of Surgery),42(24):1481-1484(曾岩,党耕町,马庆军,2004,颈椎前路融合术后颈部运动功能的评价,中华外科杂志,42(24):1481-1484)
Grabher P.,Mohammadi S.,David G.,and Freund P.,2017,Neurodegeneration in the spinal ventral horn prior to motor impairment in cervical spondylotic myelopathy,Journal of Neurotrauma,34(15):2329-2334
Ishihara A.,1968,Roentgenographic studies on the mobility of the cervical column in the sagittal plane,Nihon Seikeigeka Gakkai Zasshi,42(11):1045-1056
Jutzeler C.,Ulrich A.,Huber B.,Rosner J.,Kramer J.L.K.,and Curt A.,2017,Improved diagnosis of cervical spondylotic myelopathy with contact heat evoked potentials,Journal of Neurotrauma,34(12):2045-2053
Wang H.,Ding W.Y.,Shen Y.,Zhang Y.Z.,Zhang W.,Yang D.L.,Sun Y.P.,Wang L.F.,Cao L.Z.,and Ma L.,2012,Analysis of axial symptoms after indirect decompression for ossification of the posterior longitudinal ligament of the cervical spine,Zhonghua Waike Zazhi(Chinese Journal of Surgery),50(7):601-606(王辉,丁文元,申勇,张英泽,张为,杨大龙,孙亚澎,王林峰,曹来震,马雷,2012,颈椎后纵韧带骨化症间接减压术后轴性症状分析,中华外科杂志,50(7):601-606)
Yang S.C.,Niu C.C.,Chen W.J.,Wu C.H.,and Yu S.W.,2008,Open-door laminoplasty for multilevel cervical spondylotic myelopathy:good outcome in 12 patients using suture anchor fixation,Acta Orthopaedica,79(1):62-66
Zeng Y.,Dang G.D.,and Ma Q.J.,2004,Evaluation of neck moving ability after anterior cervical fusion,Zhonghua Waike Zazhi(Chinese Journal of Surgery),42(24):1481-1484(曾岩,党耕町,马庆军,2004,颈椎前路融合术后颈部运动功能的评价,中华外科杂志,42(24):1481-1484)