颈椎单开门微型钛板固定成形术中不同开门角度对多节段脊髓型颈椎病临床疗效的影响
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摘要
目的探讨不同开门角度颈椎单开门微型钛板固定椎管成形术治疗多节段脊髓型颈椎病的临床疗效。方法行颈椎单开门微型钛板固定椎管成形术的多节段脊髓型颈椎病患者82例,根据术后3个月复查椎板开门角度分为<35°组和≥35°组各41例。比较2组术前及术后6个月日本骨科协会评估治疗(Japanese Orthopaedic Assocation,JOA)评分、颈椎曲度指数、颈椎轴性症状和C_5神经根麻痹发生情况。结果<35°组术前、术后6个月JOA评分[(8.54±1.53)、(13.81±2.57)分]和颈椎曲度指数[(14.22±2.78)%、(12.71±1.43)%]与≥35°组[(8.72±1.55)、(14.13±2.60)分;(14.06±2.59)%、(12.57±1.40)%]比较差异无统计学意义(P>0.05);2组术后6个月JOA评分明显高于术前,颈椎曲度指数低于术前(P<0.05);<35°组术后6个月颈椎轴性症状发生率(9.76%)低于≥35°组(26.83%)(P<0.05),C_5神经根麻痹发生率(4.88%)与≥35°组(7.32%)比较差异无统计学意义(P>0.05)。结论颈椎单开门微型钛板固定椎管成形术治疗多节段脊髓型颈椎病中不同椎板开门角度与临床疗效无明显关系,开门角度过大可增加患者颈椎轴性症状发生率。
Objective To investigate the influence of different open angle on the clinical effect of single open-door minititanium plate fixation laminectomy on multi-level cervical spondylotic myelopathy.Methods Eighty-two patients with multi-level cervical spondylotic myelopathy undergoing single open-door mini-titanium plate fixation laminectomy were divided into<35°group(n=41)and ≥35°group(n=41)according to the open angle measured 3 months after operation.The spinal cord function,cervical curvature index,cervical axial symptoms and C_5 nerve root paralysis were compared between two groups.Results There were no significant differences in JOA scores(8.54±1.53,13.81±2.57)and cervical curvature indexes((14.22±2.78)%,(12.71±1.43)%)in<35°group in comparison with those in ≥35°group(8.72±1.55,14.13±2.60;(14.06±2.59)%,(12.57±1.40)%)before and 6 months after operation(P>0.05).The JOA scores in two groups were significantly higher 6 months after operation than those before operation(P<0.05),and the cervical curvature indexes were significantly lower than those before operation(P<0.05).The incidence of cervical axial symptoms was significantly lower in <35°group(9.76%)than that in ≥35°group(26.83%)(P<0.05).There was no significant difference in the incidence of C_5 nerve root palsy between<35°group(4.88%)and≥35°group(7.32%)(P>0.05).Conclusion The open angle has no influence on the clinical result of mini-titanium plate fixation laminectomy for multi-level cervical spondylotic myelopathy.The excessive large open angle would increase the incidence of cervical axial symptoms.
Objective To investigate the influence of different open angle on the clinical effect of single open-door minititanium plate fixation laminectomy on multi-level cervical spondylotic myelopathy.Methods Eighty-two patients with multi-level cervical spondylotic myelopathy undergoing single open-door mini-titanium plate fixation laminectomy were divided into<35°group(n=41)and ≥35°group(n=41)according to the open angle measured 3 months after operation.The spinal cord function,cervical curvature index,cervical axial symptoms and C_5 nerve root paralysis were compared between two groups.Results There were no significant differences in JOA scores(8.54±1.53,13.81±2.57)and cervical curvature indexes((14.22±2.78)%,(12.71±1.43)%)in<35°group in comparison with those in ≥35°group(8.72±1.55,14.13±2.60;(14.06±2.59)%,(12.57±1.40)%)before and 6 months after operation(P>0.05).The JOA scores in two groups were significantly higher 6 months after operation than those before operation(P<0.05),and the cervical curvature indexes were significantly lower than those before operation(P<0.05).The incidence of cervical axial symptoms was significantly lower in <35°group(9.76%)than that in ≥35°group(26.83%)(P<0.05).There was no significant difference in the incidence of C_5 nerve root palsy between<35°group(4.88%)and≥35°group(7.32%)(P>0.05).Conclusion The open angle has no influence on the clinical result of mini-titanium plate fixation laminectomy for multi-level cervical spondylotic myelopathy.The excessive large open angle would increase the incidence of cervical axial symptoms.
引文
[1]MACHINO M,YUKAWA Y,HIDA T,et al.Modified double-door laminoplasty in managing multilevel cervical spondylotic myelopathy:surgical outcome in 520patients and technique description[J].J Spinal Disord Tech,2013,26(3):135-140.
[2]李玉伟,王海蛟,严晓云,等.颈椎单开门椎管扩大成形术不同椎板固定方法治疗多节段脊髓型颈椎病的疗效分析[J].中国脊柱脊髓杂志,2013,23(11):973-978.
[3]金毅,赵炬才,刘珂位.颈椎后路单开门加侧块内固定治疗椎管狭窄伴颈椎不稳定疗效观察[J].中华实用诊断与治疗杂志,2010,24(2):184-185.
[4]韦敏克.颈后路椎管扩大减压微型钛板固定椎板成形术与传统颈椎后路单开门椎管扩大减压术治疗颈椎病的比较研究[J].中国矫形外科杂志,2014,22(19):1751-1755.
[5]王祥强,苗峰,卜志勇.植骨固定术与选择性减压术治疗腰椎退行性滑脱症效果比较[J].中华实用诊断与治疗杂志,2018,32(1):64-66.
[6]钟卓霖,胡建华,翟吉良,等.伴随颈椎病颈性眩晕的手术治疗[J].中华医学杂志,2015,95(25):2014-2017.
[7]曾岩,党耕町,马庆军.颈椎前路术后融合节段曲度变化与轴性症状和神经功能的相关性研究[J].中国脊柱脊髓杂志,2004,14(9):520-523.
[8]陈占磊,官众,王义生.前路减压椎间植骨融合钢板内固定术治疗多节段脊髓型颈椎病的疗效观察[J].郑州大学学报(医学版),2013,48(5):700-701.
[9]LI X,JIANG L,LIU Z,et al.Different approaches for treating multilevel cervical spondylotic myelopathy:a retrospective study of 153cases from a single spinal center[J].PLoS One,2015,10(10):e0140031.
[10]张春霖,姜岩,钟楚楠,等.脊髓型颈椎病钛板双向固定颈椎管扩大成形术治疗58例体会[J].郑州大学学报(医学版),2007,42(3):584-586.
[11]孙天威,张杭,卢守亮,等.颈椎单开门椎管扩大成形术椎板开门角度对脊髓型颈椎病疗效的影响[J].中国脊柱脊髓杂志,2012,22(1):8-13.
[12]唐超,黄金承,程旭光.单开门椎管成形术不同椎板开门角度治疗多节段脊髓型颈椎病[J].中华实验外科杂志,2014,31(11):2608-2610.
[13]谢水清,孙天威,田融,等.脊髓型颈椎病单开门椎板成形术后轴性症状的危险因素分析[J].中国修复重建外科杂志,2014,28(5):620-624.
[14]董庆磊,闫景龙.颈椎后路减压术后轴性症状的研究进展[J].实用骨科杂志,2017,23(7):626-629.
[15]SHOU F,LI Z,WANG H,et al.Prevalence of C5nerve root palsy after cervical decompressive surgery:a meta-analysis[J].Eur Spine J,2015,24(12):2724-2734.
[2]李玉伟,王海蛟,严晓云,等.颈椎单开门椎管扩大成形术不同椎板固定方法治疗多节段脊髓型颈椎病的疗效分析[J].中国脊柱脊髓杂志,2013,23(11):973-978.
[3]金毅,赵炬才,刘珂位.颈椎后路单开门加侧块内固定治疗椎管狭窄伴颈椎不稳定疗效观察[J].中华实用诊断与治疗杂志,2010,24(2):184-185.
[4]韦敏克.颈后路椎管扩大减压微型钛板固定椎板成形术与传统颈椎后路单开门椎管扩大减压术治疗颈椎病的比较研究[J].中国矫形外科杂志,2014,22(19):1751-1755.
[5]王祥强,苗峰,卜志勇.植骨固定术与选择性减压术治疗腰椎退行性滑脱症效果比较[J].中华实用诊断与治疗杂志,2018,32(1):64-66.
[6]钟卓霖,胡建华,翟吉良,等.伴随颈椎病颈性眩晕的手术治疗[J].中华医学杂志,2015,95(25):2014-2017.
[7]曾岩,党耕町,马庆军.颈椎前路术后融合节段曲度变化与轴性症状和神经功能的相关性研究[J].中国脊柱脊髓杂志,2004,14(9):520-523.
[8]陈占磊,官众,王义生.前路减压椎间植骨融合钢板内固定术治疗多节段脊髓型颈椎病的疗效观察[J].郑州大学学报(医学版),2013,48(5):700-701.
[9]LI X,JIANG L,LIU Z,et al.Different approaches for treating multilevel cervical spondylotic myelopathy:a retrospective study of 153cases from a single spinal center[J].PLoS One,2015,10(10):e0140031.
[10]张春霖,姜岩,钟楚楠,等.脊髓型颈椎病钛板双向固定颈椎管扩大成形术治疗58例体会[J].郑州大学学报(医学版),2007,42(3):584-586.
[11]孙天威,张杭,卢守亮,等.颈椎单开门椎管扩大成形术椎板开门角度对脊髓型颈椎病疗效的影响[J].中国脊柱脊髓杂志,2012,22(1):8-13.
[12]唐超,黄金承,程旭光.单开门椎管成形术不同椎板开门角度治疗多节段脊髓型颈椎病[J].中华实验外科杂志,2014,31(11):2608-2610.
[13]谢水清,孙天威,田融,等.脊髓型颈椎病单开门椎板成形术后轴性症状的危险因素分析[J].中国修复重建外科杂志,2014,28(5):620-624.
[14]董庆磊,闫景龙.颈椎后路减压术后轴性症状的研究进展[J].实用骨科杂志,2017,23(7):626-629.
[15]SHOU F,LI Z,WANG H,et al.Prevalence of C5nerve root palsy after cervical decompressive surgery:a meta-analysis[J].Eur Spine J,2015,24(12):2724-2734.