微型钛板固定与传统缝线悬吊固定在颈椎单开门术中应用效果比较

摘要

目的 比较微型钛板固定与传统缝线悬吊固定在颈椎后路单开门椎管扩大成形术中的应用效果.方法 分析51例因多节段脊髓型颈椎病(CSM)行单开门椎管扩大成形术患者的临床资料,其中24例采用传统缝线悬吊固定(A组),27例采用Centerpiece微型钛板固定(B组).比较两组手术时间、术中出血量、术后并发症、JOA评分改善率、椎管开门幅度、颈椎曲度指数及颈椎活动度变化、轴性症状评分,并评价两种手术方式的临床疗效.结果 51例患者均获得随访,随访时间:A组12~20(14.56±5.67)个月,B组11~23(16.28±4.78)个月.手术时间、术中出血量、JOA评分改善率及术后并发症两组比较差异均无统计学意义(P>0.05);两组术后JOA评分均较术前明显提高(P<0.05);术后6个月颈椎椎管开门幅度两组比较差异无统计学意义(P>0.05);颈椎曲度指数及颈椎活动度丢失B组小于A组,差异均有统计学意义(P<0.05);术后12个月轴性症状评分B组优于A组,差异有统计学意义(P<0.05).结论 传统缝线悬吊固定与微型钛板固定都是颈椎后路单开门椎管扩大成形术开门法"门轴"固定的有效方法;微型钛板内固定能提供更稳定的即刻固定,减少术后颈椎曲度的丢失,降低轴性症状的发生率.%Objective To compare the therapeutic effect between mini titanium plate instrumention and traditional suture suspension technology in cervical expansive open-door laminoplasty.Methods The 51 patients with multi-segmental CSM were treated with expansive open-door laminoplasty,which were divided into two groups according to different fixation methods,group A (n=24) was treated with traditional suture suspension fixation,whereas group B (n=27) with mini titanium plate fixation.The operation time,blood loss,surgical complications,improvement rate of JOA score,cervical spinal canal opening extent,cervical curvature index(CCI),range of motion(ROM) and axial symptoms(AS) were compared between both groups,their therapeutic effect were evaluated.Results All patients were followed up,the follow-up time was 12～20(14.56±5.67) months in group A,and 11～23(16.28±4.78) months in group B.The operation time,blood loss,improvement rate of JOA score and surgical complications showed no obvious difference between two groups(P>0.05).Postoperative JOA score were significantly increased,compared with preoperation(P<0.05).There was no significant difference between both groups in cervical spinal canal opening extent at 6 months after operation(P>0.05).As far as loss of CCI and ROM had obvious difference (P<0.05),group B was less than group A(P<0.05); and AS at 12 months after operation also had obvious difference,group B was better than group A.Conclusions The mini titanium plate fixation and suture suspension fixation are both very effective methods of “door-hinge” fixation in expansive open-door laminoplasty.However,the mini titanium plate fixation can provide more instantaneous and stable instrumention,and reduce the loss of cervical curvature after operation,which can decrease incidence rate of AS.