颈后路内固定手术方式的选择与术后疗效的相关性分析
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摘要
目的通过比较颈后路椎弓根钉(CPS)及侧块螺钉(LMS)内固定术后疗效,探讨两种术式选择的临床意义。方法 2009-02-2012-02,回顾性分析63例多节段脊髓型颈椎病(M-CSM)患者。A组M-CSM患者共31例,行后路减压CPS固定。其中,男23例,女8例;年龄42-70岁,平均57.0岁。B组M-CSM患者共32例,行后路减压LMS固定。其中,男21例,女11例;年龄45-68岁,平均56.8岁。患者常规行颈椎CT、MRI、X线(正侧、过伸过屈位)检查,分析比较患者术前、术后、随访时临床症状、颈椎曲度(CI)、轴性症状(AS)评分。结果随访时间24~48个月,平均36个月。临床症状采用JOA评分比较,A组康复率(62.1±25.2)%,B组(61.6±24.8)%,经分析无统计学意义(P>0.05)。A组CI变化率为(1.6±1.1)%,B组(3.6±2.1)%,经比较其变化差异有统计学意义(P<0.05)。A组发现明显AS比例12.9%,B组31.2%,差异有统计学意义(P<0.05)。A组未发现内固定并发症;B组患者2年随访时发现3例侧块螺钉松动现象,占比9.4%。结论颈后路手术采用椎弓根钉内固定对维持颈椎稳定性作用更为显著,亦减少明显AS发生率。提示临床制定颈后路手术方案应充分结合下颈椎解剖结构,周全考虑安全性、操作性、手术习惯等因素,选择恰当的颈后路固定方式。
Objective To compare the clinical effect of cervical pedicle screw and lateral mass screw fixation, and explore the clinical significance of choosing two different ways of operation.Methods From January 2009 to January 2012, the clinical data of 63 patients with multilevel cervical spondylotic myelopathy were reviewed in this study. Among them, 31 patients underwent cervical pedicle screw in group A,which consisted of 23 males and 8 females. The mean age was 57.0 years old(ranged 42-70). 32 patients received lateral mass screw fixation in group B,which consisted of 21 males and 11 females. The mean age was 56.8 years old(ranged 45-68). All patients underwent X-ray examination,the recovery rate was calculated using pre- and postoperative JOA scores for each patient.Postoperative cervical CI and AS were compared between two groups. Results All patients were followed up for 24-48 months(average 36 months). The average JOA recovery rate was 62.1%±25.2%in group A, and that was 61.6% ±24.8% in group B. There was no significant difference in clinical recovery rate. Loss of cervical curvature index was 1.6%±1.1% in group A, and that was 3.6%±2.1%%in group B. The difference was significant in loss of cervical curvature indices between two groups. The rate of evident axial symptoms was 12.9% in group A, and that was 31.2% in group B, the difference was statistically significant(P <0.05). The rate of fixation failure in group B was 9.4%. Conclusion The effect of pedicle screw fixation on the stability of cervical spine was more significant, and the incidence of AS was decreased significantly. To choose appropriate posterior operative ways of cervical surgery should be fully combined with cervical anatomy, consideration of safety, operability, surgical habits and other factors.
Objective To compare the clinical effect of cervical pedicle screw and lateral mass screw fixation, and explore the clinical significance of choosing two different ways of operation.Methods From January 2009 to January 2012, the clinical data of 63 patients with multilevel cervical spondylotic myelopathy were reviewed in this study. Among them, 31 patients underwent cervical pedicle screw in group A,which consisted of 23 males and 8 females. The mean age was 57.0 years old(ranged 42-70). 32 patients received lateral mass screw fixation in group B,which consisted of 21 males and 11 females. The mean age was 56.8 years old(ranged 45-68). All patients underwent X-ray examination,the recovery rate was calculated using pre- and postoperative JOA scores for each patient.Postoperative cervical CI and AS were compared between two groups. Results All patients were followed up for 24-48 months(average 36 months). The average JOA recovery rate was 62.1%±25.2%in group A, and that was 61.6% ±24.8% in group B. There was no significant difference in clinical recovery rate. Loss of cervical curvature index was 1.6%±1.1% in group A, and that was 3.6%±2.1%%in group B. The difference was significant in loss of cervical curvature indices between two groups. The rate of evident axial symptoms was 12.9% in group A, and that was 31.2% in group B, the difference was statistically significant(P <0.05). The rate of fixation failure in group B was 9.4%. Conclusion The effect of pedicle screw fixation on the stability of cervical spine was more significant, and the incidence of AS was decreased significantly. To choose appropriate posterior operative ways of cervical surgery should be fully combined with cervical anatomy, consideration of safety, operability, surgical habits and other factors.
引文
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[2]罗彬,王清,王高举,等.颈椎椎弓根钉固定结合单开门椎管扩大成形治疗颈椎管狭窄伴无骨折脱位型颈脊髓损伤的临床研究[J].中国骨与关节损伤杂志,2014,29(1):3-5.
[3]张伟,杨博贵,刘爱文,等.经前后路联合椎弓根钉内固定治疗67例颈椎骨折脱位的疗效评价[J].中国骨与关节损伤杂志,2014,29(7):645-647.
[4]向志军,钟生才,翦密华,等.颈椎椎弓根钉徒手置入技术的临床研究[J].中国骨与关节损伤杂志,2013,28(1):44-45.
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[6]孟志斌,黄涛,冯光,等.高速磨钻辅助下椎弓根钉棒系统治疗颈椎交锁性脱位[J].中华创伤杂志,2013,29(9):841-844.
[7]曲延镇,王玉龙,郭晓东,等.单纯后路椎弓根钉内固定治疗下颈椎骨折脱位[J].中华骨科杂志,2013,33(10):990-996.
[8]王远政,田晓滨,刘洋,等.Mimics及颈椎模型用于下颈椎椎弓根个体化置钉的应用研究[J].第三军医大学学报,2012,34(15):1543-1547.
[9]徐兆万,冀旭斌,王炳武,等.导向器辅助下个体化后路颈椎椎弓根螺钉固定的疗效评价[J].中华创伤杂志,2012,28(8):703-707.
[10]Yongjun W,Qi S,Lu W,et al.Cervical intervertebral disc degeneration induced by unbalanced dynamic and static forces:A novel in vivo rat model[J].Spine,2006,31(6):1532-1538.
[11]吉立新,陈仲强,范明富,等.下颈椎侧块安全置钉内固定的解剖学测量[J].中国脊柱脊髓杂志,2008,18(4):286-289.
[12]魏亦兵,周建伟,张志玉,等.下颈椎侧块螺钉固定安全性的解剖学研究[J].中华实验外科杂志,2004,21(1):97-98.
[2]罗彬,王清,王高举,等.颈椎椎弓根钉固定结合单开门椎管扩大成形治疗颈椎管狭窄伴无骨折脱位型颈脊髓损伤的临床研究[J].中国骨与关节损伤杂志,2014,29(1):3-5.
[3]张伟,杨博贵,刘爱文,等.经前后路联合椎弓根钉内固定治疗67例颈椎骨折脱位的疗效评价[J].中国骨与关节损伤杂志,2014,29(7):645-647.
[4]向志军,钟生才,翦密华,等.颈椎椎弓根钉徒手置入技术的临床研究[J].中国骨与关节损伤杂志,2013,28(1):44-45.
[5]Jones EL,Heller JG,Silcox PH,et al.Cervical pedicle screws versus lateral mass screws.Anatomic feasibility and biomechanical comparison[J].Spine,1997,22(9):977-982.
[6]孟志斌,黄涛,冯光,等.高速磨钻辅助下椎弓根钉棒系统治疗颈椎交锁性脱位[J].中华创伤杂志,2013,29(9):841-844.
[7]曲延镇,王玉龙,郭晓东,等.单纯后路椎弓根钉内固定治疗下颈椎骨折脱位[J].中华骨科杂志,2013,33(10):990-996.
[8]王远政,田晓滨,刘洋,等.Mimics及颈椎模型用于下颈椎椎弓根个体化置钉的应用研究[J].第三军医大学学报,2012,34(15):1543-1547.
[9]徐兆万,冀旭斌,王炳武,等.导向器辅助下个体化后路颈椎椎弓根螺钉固定的疗效评价[J].中华创伤杂志,2012,28(8):703-707.
[10]Yongjun W,Qi S,Lu W,et al.Cervical intervertebral disc degeneration induced by unbalanced dynamic and static forces:A novel in vivo rat model[J].Spine,2006,31(6):1532-1538.
[11]吉立新,陈仲强,范明富,等.下颈椎侧块安全置钉内固定的解剖学测量[J].中国脊柱脊髓杂志,2008,18(4):286-289.
[12]魏亦兵,周建伟,张志玉,等.下颈椎侧块螺钉固定安全性的解剖学研究[J].中华实验外科杂志,2004,21(1):97-98.