后路单开门椎管扩大椎板成形术联合Neulen钛板内固定治疗多节段脊髓型颈椎病
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摘要
目的探讨后路单开门椎管扩大椎板成形术联合Neulen钛板内固定治疗多节段脊髓型颈椎病(MCSM)的临床疗效。方法 2012年7月—2016年7月,61例MCSM患者在上海交通大学医学院附属第六人民医院接受后路单开门椎管扩大椎板成形术联合Neulen钛板内固定治疗。记录出血量、手术时间、日本骨科学会(JOA)评分、神经功能改善率、颈椎椎管矢状径、椎管扩大率、门轴侧骨愈合情况、颈椎轴性症状及围手术期并发症发生情况。结果所有手术均顺利完成,手术时间为(112.4±22.8)min,出血量为(322.8±92.8)mL。61例患者随访(3.4±1.9)年,JOA评分由术前的(9.8±2.8)分提高到末次随访时的(15.2±1.9)分;末次随访时神经功能改善率为(75.3±9.7)%;末次随访时轴性症状评分为(3.2±1.5)分,优35例、良25例、可1例。颈椎椎管矢状径由术前的(8.5±1.4)mm扩大到术后的(15.1±2.3)mm,椎管扩大率为(77.6±6.8)%;所有患者门轴侧椎板均骨愈合,无内固定断裂、松动及再关门现象发生。结论后路单开门椎管扩大椎板成形术联合Neulen钛板内固定治疗MCSM,可获得满意的临床疗效,具有即刻稳定开门椎板,有利于门轴侧椎板融合,维持椎管扩张状态,防止再关门现象发生等优点。
Objective To investigate the clinical effect of posterior open-door laminoplasty combined with Neulen titanium internal fixation in the treatment of multilevel cervical spondylotic myelopathy(MCSM). Methods From July 2012 to July 2016,61 patients with MCSM underwent posterior single-door laminoplasty combined with Neulen titanium internal fixation in Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The blood loss,operation time,Japanese Orthopaedic Association(JOA) score,improvement rate of neurological function,sagittal diameter of cervical spinal canal,expansion rate of spinal canal,hinge side bone healing,axial symptoms of the cervical spine and complications during perioperative period were recorded. Results All the operations were successfully completed. The operation time was(112.4±22.8)min,and blood loss was(322.8±92.8)m L. All the patients were followed up for(3.4±1.9)years. At the final follow-up,the JOA score increased from preoperative 9.8±2.8 to 15.2±1.9,and the improvement rate of neurological function was(75.3±9.7)%. The cervical axial symptoms score was 3.2±1.5(excellent in 35 cases,good in 25 and fair in 1) at the final follow-up. The sagittal diameter of cervical spinal canal increased from preoperative(8.5±1.4)mm to(15.1±2.3)mm,and the expansion rate of spinal canal was(77.6±6.8)%. The hinge side bone healing occurred in all the patients,without internal fixation breakage or loosening,or re-closure. Conclusion Posterior single-door laminoplasty combined with Neulen titanium internal fixation for the treatment of MCSM can obtain satisfactory clinical results. It has the advantages of immediate stability of open-door lamina,facilitating bone healing on the hinge side,maintaining the expansion of spinal canal and preventing the re-closure.
Objective To investigate the clinical effect of posterior open-door laminoplasty combined with Neulen titanium internal fixation in the treatment of multilevel cervical spondylotic myelopathy(MCSM). Methods From July 2012 to July 2016,61 patients with MCSM underwent posterior single-door laminoplasty combined with Neulen titanium internal fixation in Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The blood loss,operation time,Japanese Orthopaedic Association(JOA) score,improvement rate of neurological function,sagittal diameter of cervical spinal canal,expansion rate of spinal canal,hinge side bone healing,axial symptoms of the cervical spine and complications during perioperative period were recorded. Results All the operations were successfully completed. The operation time was(112.4±22.8)min,and blood loss was(322.8±92.8)m L. All the patients were followed up for(3.4±1.9)years. At the final follow-up,the JOA score increased from preoperative 9.8±2.8 to 15.2±1.9,and the improvement rate of neurological function was(75.3±9.7)%. The cervical axial symptoms score was 3.2±1.5(excellent in 35 cases,good in 25 and fair in 1) at the final follow-up. The sagittal diameter of cervical spinal canal increased from preoperative(8.5±1.4)mm to(15.1±2.3)mm,and the expansion rate of spinal canal was(77.6±6.8)%. The hinge side bone healing occurred in all the patients,without internal fixation breakage or loosening,or re-closure. Conclusion Posterior single-door laminoplasty combined with Neulen titanium internal fixation for the treatment of MCSM can obtain satisfactory clinical results. It has the advantages of immediate stability of open-door lamina,facilitating bone healing on the hinge side,maintaining the expansion of spinal canal and preventing the re-closure.
引文
[1]Tong MJ,Hu YB,Wang XY,et al.The spinal cord line can predict postoperative recovery for multilevel cervical spondylotic myelopathy[J].World Neurosurg,2017,104:361-366.
[2]Lau D,Winkler EA,Than KD,et al.Laminoplasty versus laminectomy with posterior spinal fusion for multilevel cervical spondylotic myelopathy:influence of cervical alignment on outcomes[J].J Neurosurg Spine,2017,27(5):508-517.
[3]Arrojas A,Jackson JB 3rd,Grabowski G.Trends in the treatment of single and multilevel cervical stenosis:a review of the american board of orthopaedic surgery database[J].J Bone Joint Surg Am,2017,99(18):e99.
[4]Minamide A,Yoshida M,Simpson AK,et al.Microendoscopic laminotomy versus conventional laminoplasty for cervical spondylotic myelopathy:5-year follow-up study[J].J Neurosurg Spine,2017,27(4):403-409.
[5]鲍达,于龙,李大伟,等.两种固定方法在颈椎单开门椎管扩大椎板成形术中的比较研究[J].脊柱外科杂志,2017,15(5):262-267.
[6]Yonenobu K,Abumi K,Nagata K,et al.Interobserver and intraobserver reliability of the Japanese Orthopaedic Association scoring system for evaluation of cervical compression myelopathy[J].Spine(Phila Pa 1976),2001,26(17):1890-1895.
[7]张仁赞,张学利,胡炜,等.EOLP不同椎板固定方法对颈椎曲度及轴性症状的影响[J].重庆医学,2016,45(6):782-786.
[8]唐向盛,谭明生,移平,等.改良法单开门椎管扩大椎板成形术治疗颈椎后纵韧带骨化症合并颈椎不稳的疗效评价[J].脊柱外科杂志,2018,16(1):3-7.
[9]Li Z,Wang H,Tang J,et al.Comparison of three reconstructive techniques in the surgical management of patients with four-level cervical spondylotic myelopathy[J].Spine(Phila Pa 1976),2017,42(10):E575-E583.
[10]Michael KW,Neustein TM,Rhee JM.Where should a laminoplasty start?The effect of the proximal level on post-laminoplasty loss of lordosis[J].Spine J,2016,16(6):737-741.
[11]Tamai K,Suzuki A,Terai H,et al.Laminar closure after expansive open-door laminoplasty:fixation methods and cervical alignments impact on the laminar closure and surgical outcomes[J].Spine J,2016,16(9):1062-1069.
[12]Bai C,Li K,Guo A,et al.Indication for hypertrophy posterior longitudinal ligament removal in anterior decompression for cervical spondylotic myelopathy[J].Medicine(Baltimore),2017,96(23):e7043.
[13]Takeshima Y,Matsuoka R,Nakagawa I,et al.Surgical outcome of laminoplasty for cervical spondylotic myelopathy in an elderly population-potentiality for effective early surgical intervention:a meta-analysis[J].Neurol Med Chir(Tokyo),2017,57(7):366-373.
[2]Lau D,Winkler EA,Than KD,et al.Laminoplasty versus laminectomy with posterior spinal fusion for multilevel cervical spondylotic myelopathy:influence of cervical alignment on outcomes[J].J Neurosurg Spine,2017,27(5):508-517.
[3]Arrojas A,Jackson JB 3rd,Grabowski G.Trends in the treatment of single and multilevel cervical stenosis:a review of the american board of orthopaedic surgery database[J].J Bone Joint Surg Am,2017,99(18):e99.
[4]Minamide A,Yoshida M,Simpson AK,et al.Microendoscopic laminotomy versus conventional laminoplasty for cervical spondylotic myelopathy:5-year follow-up study[J].J Neurosurg Spine,2017,27(4):403-409.
[5]鲍达,于龙,李大伟,等.两种固定方法在颈椎单开门椎管扩大椎板成形术中的比较研究[J].脊柱外科杂志,2017,15(5):262-267.
[6]Yonenobu K,Abumi K,Nagata K,et al.Interobserver and intraobserver reliability of the Japanese Orthopaedic Association scoring system for evaluation of cervical compression myelopathy[J].Spine(Phila Pa 1976),2001,26(17):1890-1895.
[7]张仁赞,张学利,胡炜,等.EOLP不同椎板固定方法对颈椎曲度及轴性症状的影响[J].重庆医学,2016,45(6):782-786.
[8]唐向盛,谭明生,移平,等.改良法单开门椎管扩大椎板成形术治疗颈椎后纵韧带骨化症合并颈椎不稳的疗效评价[J].脊柱外科杂志,2018,16(1):3-7.
[9]Li Z,Wang H,Tang J,et al.Comparison of three reconstructive techniques in the surgical management of patients with four-level cervical spondylotic myelopathy[J].Spine(Phila Pa 1976),2017,42(10):E575-E583.
[10]Michael KW,Neustein TM,Rhee JM.Where should a laminoplasty start?The effect of the proximal level on post-laminoplasty loss of lordosis[J].Spine J,2016,16(6):737-741.
[11]Tamai K,Suzuki A,Terai H,et al.Laminar closure after expansive open-door laminoplasty:fixation methods and cervical alignments impact on the laminar closure and surgical outcomes[J].Spine J,2016,16(9):1062-1069.
[12]Bai C,Li K,Guo A,et al.Indication for hypertrophy posterior longitudinal ligament removal in anterior decompression for cervical spondylotic myelopathy[J].Medicine(Baltimore),2017,96(23):e7043.
[13]Takeshima Y,Matsuoka R,Nakagawa I,et al.Surgical outcome of laminoplasty for cervical spondylotic myelopathy in an elderly population-potentiality for effective early surgical intervention:a meta-analysis[J].Neurol Med Chir(Tokyo),2017,57(7):366-373.