摘要
目的:观察3种颈椎后路单开门椎管扩大成形术的临床疗效和安全性。方法:回顾性分析105例多节段颈段脊髓受压患者的病例资料,采用单开门丝线悬吊椎管扩大成形术治疗者35例(丝线固定组),采用单开门带线锚钉固定椎管扩大成形术治疗者37例(锚钉固定组),采用单开门微型钛板固定椎管扩大成形术治疗者33例(钛板固定组)。比较3组患者的手术时间、出血量、住院时间、JOA评分、最窄椎管面积、颈椎活动度、颈椎曲率指数及并发症发生情况。结果:1一般情况。3组患者手术时间、出血量及住院时间比较,组间差异均有统计学意义[(68.4±18.6)min,(79.8±21.3)min,(86.1±25.9)min,F=13.560,P=0.000;(346.3±85.7)m L,(364.1±83.2)m L,(436.2±89.4)m L,F=14.317,P=0.000;(53.3±4.8)d,(52.4±3.7)d,(32.4±4.5)d,F=19.492,P=0.000]。钛板固定组手术时间、出血量大于其余2组(P=0.000,P=0.000;P=0.000,P=0.000),住院时间比其余2组短(P=0.000,P=0.000);丝线固定组和锚钉固定组的手术时间、出血量及住院时间比较,组间差异均无统计学意义(P=0.326,P=0.824,P=0.536)。2JOA评分。手术前后不同时间JOA评分的差异有统计学意义,即存在时间效应[(7.5±3.6)分,(12.7±3.3)分,(13.2±3.7)分;(8.3±3.7)分,(12.8±3.8)分,(12.4±3.3)分;(7.6±2.5)分,(13.2±2.7)分,(14.5±2.6)分;F=56.672,P=0.000]。3组患者JOA评分的组间差异总体上有统计学意义,即存在分组效应(F=45.718,P=0.000);术前和术后1周时3组患者JOA评分比较,组间差异均无统计学意义(F=1.315,P=0.692;F=1.047,P=0.739);术后2年时,钛板固定组评分高于其余2组(P=0.002,P=0.000),其余2组间比较,差异无统计学意义(P=0.336)。时间因素和分组因素之间不存在交互效应(F=0.372,P=1.041)。3最窄椎管面积。手术前后不同时间最窄椎管面积的差异有统计学意义,即存在时间效应[(136.2±35.1)mm2,(274.3±42.5)mm2,(242.6±38.3)mm2;(135.7±32.6)mm2,(272.9±42.3)mm2,(258.7±35.4)mm2;(135.9±34.9)mm2,(275.1±45.8)mm2,(274.1±34.3)mm2;F=45.296,P=0.000]。3组患者最窄椎管面积的组间差异总体上有统计学意义,即存在分组效应(F=36.342,P=0.000);术前和术后1周时3组患者最窄椎管面积比较,组间差异均无统计学意义(F=6.260,P=0.103;F=4.614,P=0.527);术后2年时,钛板固定组最窄椎管面积大于其余2组(P=0.000,P=0.000),锚钉固定组大于丝线固定组(P=0.003)。时间因素和分组因素之间不存在交互效应(F=1.547,P=0.876)。4颈椎活动度和颈椎曲率指数。术前3组患者的颈椎活动度和颈椎曲率指数比较,组间差异均无统计学意义[(36.3°±5.7°),(35.9°±5.2°),(36.8°±6.5°),F=0.302,P=1.045;(11.4±4.5)mm,(12.4±2.9)mm,(11.9±3.6)mm,F=0.237,P=1.739]。术后2年时3组患者的颈椎活动度和颈椎曲率指数比较,组间差异均有统计学意义[(26.7°±2.8°),(28.3°±3.1°),(34.5°±2.7°),F=10.365,P=0.000;(7.5±2.6)mm,(8.3±4.1)mm,(11.2±3.8)mm,F=9.507,P=0.003];钛板固定组的颈椎活动度和颈椎曲率指数均大于其余2组(P=0.000,P=0.000;P=0.000,P=0.000),其余2组间比较,差异均无统计学意义(P=0.813,P=0.438)。5并发症。丝线固定组5例患者术后早期出现上肢麻木,给予地塞米松后缓解;锚钉固定组3例患者术后发热,给予解热镇痛药后缓解;钛板固定组2例患者发生脑脊液漏,3 d后消失。所有患者的手术切口均甲级愈合,未发生锚钉脱出、钛板松动或断裂等并发症。结论:3种颈椎后路单开门椎管扩大成形术均能增加脊髓受压患者病变部位椎管面积、减小颈椎活动度和颈椎曲率指数、改善患者神经功能;与丝线悬吊固定相比,锚钉固定和微型钛板固定更加牢固,可有效防止再关门现象;微型钛板固定的疗效最好,但手术操作费时、创伤较大。
Objective：To observe the clinical curative effects and safety of three kinds of cervical unilateral open-door laminoplasty in posterior access.Methods：The medical records of 105 patients with multiple-segment cervical spinal cord compression were analyzed retro-spectively.The patients were treated with unilateral open-door laminoplasty and the open vertebral plates were fixed with suture silk（35 ）, suture anchor（37）and micro titanium plate（33）.The operative time,blood loss,hospital stay,JOA scores,minimal cross-sectional area of the vertebral canal,range of motion（ROM）of cervical vertebrae,cervical curvature index（CCI）and complications were compared between the 3 groups.Results：There was statistical difference in the operative time,blood loss and hospital stay between the 3 groups（68.4 ＋/-18.6,79.8＋/-21.3,86.1 ＋/-25.9 min,F=13.560,P=0.000;346.3＋/-85.7,364.1 ＋/-83.2,436.2＋/-89.4 mL,F=14.317,P=0.000;53.3＋/-4.8,52.4＋/-3.7,32.4＋/-4.5 d,F=19.492,P=0.000）.The operative time and blood loss of titanium plate group were greater than those of the other 2 groups（P=0.000,P=0.000;P=0.000,P=0.000）,while the hospital stay of titanium plate group was shorter than that of the other 2 groups（P=0.000,P=0.000）.There was no statistical difference in the operative time,blood loss and hospital stay between suture silk group and suture anchor group（P=0.326,P=0.824,P=0.536）.There was statistical difference in JOA scores between different time points,in other words,there was time effect（7.5 ＋/-3.6,12.7 ＋/-3.3,13.2 ＋/-3.7 points;8.3 ＋/-3.7, 12.8＋/-3.8,12.4＋/-3.3 points;7.6＋/-2.5,13.2＋/-2.7,14.5 ＋/-2.6 points;F=56.672,P=0.000）.In general,there was statis-tical difference in JOA scores between the three groups,in other words,there was group effect（F=45.718,P=0.000）.There was no sta-tistical difference in JOA scores between the three groups before treatment and one week after the treatment（F=1.315,P=0.692;F=1.047,P=0.739）.The JOA scores of the titanium plate group were higher than those of the other two groups 2 years after the treatment （P=0.002,P=0.000）,and there was no statistical difference in JOA scores between suture silk group and suture anchor group（P=0.336）.There was no interaction between time factor and grouping factor（F=0.372,P=1.041）.There was statistical difference in the minimal cross-sectional area of the vertebral canal between different time points,in other words,there was time effect（136.2 ＋/-35.1, 274.3＋/-42.5,242.6＋/-38.3 mm（2）;135.7＋/-32.6,272.9＋/-42.3,258.7 ＋/-35.4 mm（2）;135.9 ＋/-34.9,275.1 ＋/-45.8, 274.1 ＋/-34.3 mm（2）;F=45.296,P=0.000）.In general,there was statistical difference in the minimal cross-sectional area of the vertebral canal between the three groups,in other words,there was group effect（F=36.342,P=0.000）.There was no statistical difference in the minimal cross-sectional area of the vertebral canal between the three groups before treatment and one week after the treatment（F=6.260,P=0.103;F=4.614,P=0.527）.The minimal cross-sectional area of the vertebral canal of the titanium plate group were larger than those of the other two groups 2 years after the treatment（P=0.000,P=0.000）,and the suture anchor group surpassed the suture silk fixation group（P=0.003）.There was no interaction between time factor and grouping factor（F=1.547,P=0.876）.There was no statisti-cal difference in ROMof cervical vertebrae and CCI between the three groups before the treatment（36.3＋/-5.7,35.9＋/-5.2,36.8＋/-6.5 degrees,F=0.302,P=1.045;11.4＋/-4.5,12.4＋/-2.9,11.9 ＋/-3.6 mm,F=0.237,P=1.739）.There was statistical differ-ence in ROMof cervical vertebrae and CCI between the three groups 2 years after the treatment（26.7＋/-2.8,28.3＋/-3.1,34.5 ＋/-2.7 degrees,F=10.365,P=0.000;7.5 ＋/-2.6,8.3＋/-4.1,11.2＋/-3.8 mm,F=9.507,P=0.003）.The ROMof cervical vertebrae and CCI of the titanium plate group were higher than those of the other 2 groups（P=0.000,P=0.000;P=0.000,P=0.000）,and there was no statistical difference in ROM of cervical vertebrae and CCI between suture silk group and suture anchor group（P=0.813,P=0.438）. Early upper limb numbness was found in 5 patients in suture silk group after the surgery,and the symptoms were relieved after treatment with dexamethasone.Fever was found in 3 patients in suture anchor group after the surgery,and the symptoms were relieved after treatment with antipyretic analgesic.The leakage of cerebrospinal fluid was found in 2 patients in titanium plate group after the surgery,and the symp-toms disappeared 3 days later.All of the patients in the 3 groups got primary healing in the operative incisions and no complications were found such as anchor prolapse,titanium-plate loosening or fragmentation.Conclusion：For treatment of spinal cord compression,all of the three kinds of cervical unilateral open-door laminoplasty in posterior access can increase the cross-sectional area of vertebral canal and de-crease the ROM of cervical vertebrae and CCI and improve the nerve function.Suture anchor fixation and micro titanium plate fixation were firmer than suture silk fixation and they can effectively prevented reclose-door of vertebral canal.The micro titanium plate fixation has the best curative effect,while it has such disadvantages as more operative time and much invasion.
出处
《中医正骨》
2014年第12期19-24,共6页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
南京军区医学科技创新课题(11MB028)
关键词
颈椎
脊髓压迫症
椎间盘移位
后纵韧带骨化
椎管扩大成形术
Cervical vertebrae
Spinal cord compression
Intervertebral disc displacement
Ossification of posterior longitudinal ligament
Laminoplasty
