颈前路减压融合术后再手术行Arch钛板颈后路单开门椎管扩大成形术的疗效分析

摘要

目的 回顾性分析Arch钛板颈后路单开门椎管扩大成形术作为颈前路减压融合术患者再手术方式的疗效.方法 初次行颈前路减压植骨融合术并于本院再手术行Arch钛板单开门椎管扩大成形术的患者共10例,比较再次术前及随访时日本骨科学会(Japanese Orthopaedic Association,JOA)评分、Cobb角和颈椎活动度的变化,同时比较再次手术前后椎管面积的变化.结果 患者平均随访11.9个月,JOA评分由术前平均7.6分增加至11.3分(P＜0.01),神经功能改善率为41.83%;术前和末次随访时的Cobb角、颈椎活动度差异无统计学意义(P>0.05);椎管面积由术前171.32 mm2增大至227.46 mm2(P＜0.05).术后2例患者出现轴性痛,1例出现脑脊液漏;随访期间完全恢复.结论 对于行颈前路减压融合术的患者,应用Arch钛板单开门椎管扩大成形术作为再次手术方式在短期内安全、有效.%Objective To evaluated the effectiveness and indication of the Arch titanium plate modified one-door-open laminoplasty as revision surgery for cases who had failed primary cervical anterior decompression and fusion( ADF ). Methods A total of 10 cases who underwent primary failed ADF and had reoperation with the Arch titanium plate modified one-door-open laminoplasty were included. Comparisons of Japanese Orthopaedic Association ( JOA ) score, Cobb' s angle, range of motion( ROM ) and spinal canal area between pre-operation and follow-up were carried out. Results By the end of follow-up( mean 11.9 months ), the mean JOA score had significantly increased from 7.6 to 11.3, with the average improvement rate as 41. 83% ( P <0.01 ). There weren' t significant differences of Cobb' s angle and ROM between the preoperative and follow-up ( P > 0.05 ). The spinal canal areas in operation-segment significantly enlarged from 171.32 to 227.46 mm2 after the operation calculated on CT ( P <0.05 ). Only 2 patients experienced reversible axial syndrome, and 1 patient had controllable cerebrospinal fluid leak; all 3 patients were recovery at final follow-up. Conclusion The Arch titanium plate modified one-door open laminoplasty is a safe and effective revision surgical approach for patients with a failed anterior cervical surgery in a short-term.