摘要：
Objective To observe the effect of different fixation methods on cervical curvature and axial symptoms in posterior cervical single?door surgery??Methods From September 2014 to February 2016, 112 patients with multi?segment cervical spondylotic myelopathy underwent surgical treatment in Handan Central Hospital of Hebei Province??According to the lamina fixation methods,they were divided into groups A,B and C??There were 35 cases in group A,using suture suspension method to fix lamina; 34 cases in group B,using anchor suspension to fix lamina;and 43 cases in group C,using mini?titanium plate to fix lamina The operation time,intraoperative blood loss,laminae open angle,spinal drift distance,postoperative neurological recovery,cervical curvature index ( CCI ) and occurrence of axonal symptoms were compared in each group??Results All patients underwent surgery successfully??There were no significant differences in operation time,intraoperative blood loss,laminae open angle and spinal drift distance between the 3 groups (all P＞0??05)??The JOA score of group A was (7??9± 2??2) preoperatively,(9??3± 2??8) at 3 months after surgery,and (13??9±3??4) at the final follow?up??In Group B was (7??7±2??0) preoperatively,(9??1±2??7) at 3 months after surgery,and (13??6±3??7) at the final follow?up??In Group C was (7??8±2??1),( 9??0±2??6) and (13??8 ± 3??5 ), respectively, there were significant differences before and after operation ( Fintra?grouP＝7??271, Pintra?grouP ＜ 0??001; Finter?grouP ＝ 11??372, Pinter?grouP ＜ 0??001; Finteraction ＝ 9??831, Pinteraction＜0??001)??The CCI of group A was ( 22??7± 5??6)% preoperatively,(20??5± 4??4)% at 3 months after surgery,and (16??6± 3??0)% at the final follow?up??The CCI of group B was ( 21??4 ± 5??2)%,( 19??7 ±4??1)% and (17??8±2??9)% respectively??The CCI of group C was ( 21??1 ± 5??0)%,( 20??8 ± 4??6)% and (19??8 ± 4??0)% respectively??There were significant differences between group A and group B in the last follow?up and the three months before and after operation??( all P＜0??05),there was no significant difference between groups C at different time points ( P＞0??05)??According to the visual analogue scoring system,the distribution of axial symptoms in group C was significantly better than that in group A and group B ( Z＝6??678;P＝0??035)??Conclusion Posterior single?door mini?titanium plate fixation can not only improve nerve function,but also prevent cervical curvature loss and reduce the occurrence of axonal symptoms??%目的 观察颈后路单开门术中椎板不同固定方法对颈椎曲度及轴性症状的影响.方法 选择河北省邯郸市中心医院2014年9月至2016年2月行手术治疗的112例多节段脊髓型颈椎病患者的临床资料,根据椎板固定方法不同将患者分为A、B、C组,A组35例,采用缝线悬吊法固定椎板;B组34例,采用锚钉悬吊固定椎板;C组43例,采用微型钛板固定椎板;比较各组患者手术时间、术中出血量、椎板开门角度、脊髓漂移距离、术后神经功能恢复、颈椎曲度指数( cervical curvature index,CCI)变化及轴性症状的发生情况.结果 所有患者均顺利接受手术,3组患者在手术时间、术中出血量、椎板开门角度及脊髓漂移距离比较差异均无统计学意义( P均＞0??05). A组患者JOA评分术前为(7??9±2??2)分,术后3个月为( 9??3 ± 2??8)分,末次随访为( 13??9± 3??4)分;B组分别为( 7??7 ±2??0)、(9??1±2??7)、(13??6±3??7)分;C组分别为(7??8±2??1)、(9??0±2??6)、(13??8±3??5)分,3组比较差异均有统计学意义(F组内＝7??271,P组内＜0??001;F组间＝11??372,P组间＜0??001;F交互＝9??831,P交互＜0??001).A组患者CCI术前为(22??7±5??6)%、术后3个月为(20??5±4??4)%、末次随访为(16??6±3??0)%,B组患者分别为(21??4±5??2)%、(19??7± 4??1)%、(17??8± 2??9)%,C 组患者分别为(21??1± 5??0)%、(20??8 ±4??6)%、(19??8±4??0)%,A、B组患者CCI末次随访与术前、术后3个月比较差异均有统计学意义(P均＜0??05),C组患者不同时间点间比较差异无统计学意义(P＞0??05).根据视觉模拟评分系统,C组轴性症状分布情况明显优于A组和B组(Z＝6??678,P＝0??035).结论 后路单开门微型钛板固定在获得神经功能明显改善的同时,可以更好的防止颈椎曲度丢失并降低轴性症状的发生.
