微型钛板内固定联合伸肌附着点重建椎管成形术治疗累及C_2节段脊髓型颈椎病的效果分析
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摘要
目的观察微型钛板内固定联合伸肌附着点重建单开门椎管扩大成形术治疗累及C_2节段脊髓型颈椎病的临床疗效。方法回顾性分析自2014-02—2016-11诊治的21例累及C_2节段脊髓型颈椎病,行单开门椎管扩大成形微型钛板内固定联合伸肌群附着点重建术。观察术后患者神经功能恢复、颈椎曲度改变、颈后肌群萎缩及轴性症状发生的情况。结果 21例均获得随访,随访时间平均15.8(13～18)个月。术后3个月JOA评分较术前明显提高,差异有统计学意义(P <0.05);而末次随访时JOA评分与术后3个月比较差异无统计学意义(P>0.05)。术前、术后3个月、末次随访时颈椎曲度指数比较差异无统计学意义(P>0.05)。末次随访时C_2矢状径长度由术前(9.1±2.3)mm增至(14.6±3.4)mm,差异有统计学意义(P <0.05)。末次随访时颈后肌群横截面积与术前比较差异无统计学意义(P>0.05)。术后轴性症状评定结果:优11例,良7例,可2例,差1例,轴性症状发生率为14.3%。结论单开门椎管扩大成形微型钛板内固定术是治疗累及C_2节段脊髓型颈椎病的有效术式,能够显著促进神经功能恢复,钛板内固定可增强颈椎稳定性,重建伸肌附着点可以减轻颈后肌群的萎缩程度,从而降低后凸畸形及轴性症状的发生率。
Objective To observe the effect of titanium plate fixation combined with extensor attachment point reconstruction for the treatment of cervical spondylotic myelopathy(CSM) involving C_2 segment. Methods From February 2014 to November 2016, 21 patients with CSM involving C_2 segment underwent open-door laminoplasty with titanium plate fixation and extension muscle attachment reconstruction. The postoperative neurological recovery, cervical curvature index, atrophy of the back muscles and axial symptoms were recorded and analyzed. Results All patients were followed up for an average of15.8 months(arrange 13-18 months). The JOA score was significantly improved at 3 months after operation( P <0.05), but there was no significant difference at the final follow-up and 3 months after surgery(P >0.05). The cervical curvature index sustained well at 3 months after surgery and at final follow-up compared with the preoperative level( P >0.05). The C_2 sagittal diameter increased from(9.1±2.3) mm preoperatively to(14.6±3.4) mm postoperatively(P <0.05). The cross-sectional area of the posterior cervical muscle had no significant reduction at final follow up(P >0.05). The axial symptoms occurred in three patients(14.3%). Based on the axial symptom criterion, the result was excellent in 11 patients, good in 7, fair in 2, and poor in 1, the incidence of axial symptoms was 14.3%. Conclusion Laminoplasty with titanium plate fixation and extensor attachment point reconstruction is effective for CSM involving C_2 segment, which reduce the atrophy of the posterior cervical muscles, avoid the occurrence of kyphotic deformity and decrease the occurrence of axial symptoms.
Objective To observe the effect of titanium plate fixation combined with extensor attachment point reconstruction for the treatment of cervical spondylotic myelopathy(CSM) involving C_2 segment. Methods From February 2014 to November 2016, 21 patients with CSM involving C_2 segment underwent open-door laminoplasty with titanium plate fixation and extension muscle attachment reconstruction. The postoperative neurological recovery, cervical curvature index, atrophy of the back muscles and axial symptoms were recorded and analyzed. Results All patients were followed up for an average of15.8 months(arrange 13-18 months). The JOA score was significantly improved at 3 months after operation( P <0.05), but there was no significant difference at the final follow-up and 3 months after surgery(P >0.05). The cervical curvature index sustained well at 3 months after surgery and at final follow-up compared with the preoperative level( P >0.05). The C_2 sagittal diameter increased from(9.1±2.3) mm preoperatively to(14.6±3.4) mm postoperatively(P <0.05). The cross-sectional area of the posterior cervical muscle had no significant reduction at final follow up(P >0.05). The axial symptoms occurred in three patients(14.3%). Based on the axial symptom criterion, the result was excellent in 11 patients, good in 7, fair in 2, and poor in 1, the incidence of axial symptoms was 14.3%. Conclusion Laminoplasty with titanium plate fixation and extensor attachment point reconstruction is effective for CSM involving C_2 segment, which reduce the atrophy of the posterior cervical muscles, avoid the occurrence of kyphotic deformity and decrease the occurrence of axial symptoms.
引文
[1]何保华,朱伟,夏虹,等.改良与传统椎管扩大成形术治疗多节段脊髓型颈椎病的疗效比较[J].中国骨与关节损伤杂志,2017,32(11):1167-1169.
[2]于雷,袁绍辉.多节段脊髓型颈椎病手术策略的研究进展[J].医学综述,2018,24(1):117-121.
[3]宋将,郝清海,刘涛,等.颈前路ACCF联合ACDF治疗多节段脊髓型颈椎病的疗效观察[J].中国骨与关节损伤杂志,2018,33(1):49-51.
[4]李鹏飞,贾楠,王立红,等.颈后路4种手术方式对颈椎曲度及轴性症状的研究[J].河北医科大学学报,2017,38(1):24-28.
[5]李东风,刘法敬,胡成栋,等.保留颈后方韧带复合体的单开门微型钛板固定椎管成形术治疗脊髓型颈椎病的临床效果[J].广西医学,2016,38(11):1502-1504.
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[8]Takeuchi K,Yokoyama T,Aburakawa S,et al.Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-C7 laminoplasty:a modified laminoplasty preserving the semispinalis cervicis inserted into axis[J].Spine(Phila Pa 1976),2005,30(22):2544-2549.
[9]赵焕融,徐宝山,邵鹏飞,等.保留后韧带复合体的颈椎管扩大成形术的解剖学研究[J].中华医学杂志,2017,97(47):3687-3692.
[10]蒋继乐,田伟.颈椎椎管成形术后轴性症状相关研究进展[J].中华骨科杂志,2017,37(9):569-576.
[11]李广章,蒋召芹,刘志新.改良颈椎后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病的对比研究[J].川北医学院学报,2017,32(5):709-711.
[12]李玉伟,严晓云,王海蛟,等.保留C2、3棘突肌肉附着点的改良颈椎管扩大成形术[J].中国矫形外科杂志,2016,24(1):30-34.
[13]余翔,姜亮,刘忠军.颈后路保留肌肉韧带复合体椎管扩大成形术的研究进展[J].中国脊柱脊髓杂志,2017,27(9):842-845.
[14]Suh BG,Ahn MW,Kim HJ,et al.Wedge-shaped resection of the posterior bony arch during open door laminoplasty to prevent postoperative motion limitation[J].Spine(Phila Pa 1976),2017,42(3):143-150.
[15]Sakai K,Yoshii T,Hirai T,et al.Impact of the surgical treatment for degenerative cervical myelopathy on the preoperative cervical sagittal balance:a review of prospective comparative cohort between anterior decompression with fusion and laminoplasty[J].Eur Spine J,2017,26(1):104-112.
[2]于雷,袁绍辉.多节段脊髓型颈椎病手术策略的研究进展[J].医学综述,2018,24(1):117-121.
[3]宋将,郝清海,刘涛,等.颈前路ACCF联合ACDF治疗多节段脊髓型颈椎病的疗效观察[J].中国骨与关节损伤杂志,2018,33(1):49-51.
[4]李鹏飞,贾楠,王立红,等.颈后路4种手术方式对颈椎曲度及轴性症状的研究[J].河北医科大学学报,2017,38(1):24-28.
[5]李东风,刘法敬,胡成栋,等.保留颈后方韧带复合体的单开门微型钛板固定椎管成形术治疗脊髓型颈椎病的临床效果[J].广西医学,2016,38(11):1502-1504.
[6]Healy AT,Lubelski D,West JL,et al.Biomechanics of open-door laminoplasty with and without preservation of posterior structures[J].J Neurosurg Spine,2016,24(5):746-751.
[7]曾岩,党耕町,马庆军.颈椎前路融合术后颈部运动功能的评价[J].中华外科杂志,2004,42(24):1181-1184.
[8]Takeuchi K,Yokoyama T,Aburakawa S,et al.Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-C7 laminoplasty:a modified laminoplasty preserving the semispinalis cervicis inserted into axis[J].Spine(Phila Pa 1976),2005,30(22):2544-2549.
[9]赵焕融,徐宝山,邵鹏飞,等.保留后韧带复合体的颈椎管扩大成形术的解剖学研究[J].中华医学杂志,2017,97(47):3687-3692.
[10]蒋继乐,田伟.颈椎椎管成形术后轴性症状相关研究进展[J].中华骨科杂志,2017,37(9):569-576.
[11]李广章,蒋召芹,刘志新.改良颈椎后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病的对比研究[J].川北医学院学报,2017,32(5):709-711.
[12]李玉伟,严晓云,王海蛟,等.保留C2、3棘突肌肉附着点的改良颈椎管扩大成形术[J].中国矫形外科杂志,2016,24(1):30-34.
[13]余翔,姜亮,刘忠军.颈后路保留肌肉韧带复合体椎管扩大成形术的研究进展[J].中国脊柱脊髓杂志,2017,27(9):842-845.
[14]Suh BG,Ahn MW,Kim HJ,et al.Wedge-shaped resection of the posterior bony arch during open door laminoplasty to prevent postoperative motion limitation[J].Spine(Phila Pa 1976),2017,42(3):143-150.
[15]Sakai K,Yoshii T,Hirai T,et al.Impact of the surgical treatment for degenerative cervical myelopathy on the preoperative cervical sagittal balance:a review of prospective comparative cohort between anterior decompression with fusion and laminoplasty[J].Eur Spine J,2017,26(1):104-112.