摘要
目的探讨Arch钛板固定与侧块螺钉钛棒固定在治疗颈椎后纵韧带骨化症中的疗效比较。方法 2012年3月至2016年3月,徐州医科大学附属医院骨科对33例行后路单开门椎管扩大成形术治疗颈椎后纵韧带骨化症的患者进行回顾性分析,并获得随访患者的临床资料,其中应用侧块螺钉固定的患者18例,应用Arch钛板固定的患者15例。依据不同手术方法分为侧块螺钉组和Arch钛板组。比较两组患者手术前后JOA评分(17分法)、术前及术后6个月C4节段椎管矢状径,术后3d和术后6个月的开门角度及开门角度丢失情况,术前和末次随访SF-36生活质量及颈椎活动度评测。以JOA评分及其改善率评价术后神经功能改善情况;术后复查颈椎X线片、CT及MRI,在术后6个月颈椎CT片上测量C4节段椎管矢状径,计算椎管扩大率及开门角度,评价门轴侧骨性愈合情况;记录所有术中及术后并发症。结果随访时间6~24个月。侧块螺钉组,手术时间(143.06±22.44)min,术中出血量(256.95±32.23)mL。Arch钛板组,手术时间(130.67±21.03)min,术中出血量(238.67±27.02)mL。两组手术时间及术中出血量比较,差异均无统计学意义(P>0.05)。侧块螺钉组JOA评分:术前为(8.39±2.38)分,术后6个月为(12.00±2.20)分,JOA评分改善率(44.16±14.68)%。Arch钛板组JOA评分:术前为(8.53±2.70)分,术后6个月为(14.07±2.31)分,JOA评分改善率(68.56±15.73)%。两组患者JOA评分改善率比较,差异有统计学意义(P<0.01)。侧块螺钉组C4节段椎管矢状径:术前为(6.20±1.26)mm,术后6个月为(10.31±2.15)mm。Arch钛板组C4节段椎管矢状径:术前为(6.39±1.39)mm,术后6个月为(12.43±3.19)mm。两组患者术前C4节段椎管矢状径比较,差异无统计学意义(P>0.05),术后比较差异有统计学意义(P<0.05)。侧块螺钉组术后6个月椎管开门角度为(25.57±3.95)°,Arch钛板组为(29.67±4.16)°。两组患者开门角度、开门角度丢失比较,差异有统计学意义(P<0.01)。两组患者末次随访SF-36生活质量评分、颈椎活动度比较,差异有统计学意义(P<0.01)。侧块螺钉组术后发生再关门现象1例,发生轴性症状5例,对症治疗后缓解。Arch钛板组术后无再关门现象及轴性症状发生。两组患者均无内固定弯曲、断裂现象。术后6个月MRI检查见脊髓受压明显缓解。结论在单开门颈椎管扩大成形术中,相对于侧块螺钉固定,Arch钛板固定的手术时间及术中出血量差异无统计学意义,术后JOA改善率及椎管扩大效果均优于侧块螺钉固定,而且可以有效避免轴性症状及再关门现象的发生,保留了颈椎活动度,是治疗颈椎后纵韧带骨化症的一种安全、有效的方法,早期临床疗效满意。
Objective To compare the efficacy of Arch titanium plate fixation with lateral mass screws and titanium bars in the treatment of ossification of the posterior longitudinal ligament（OPLL）of the cervical spine.Methods From March 2012 to March 2016,33 patients suffering from posterior unilateral open-door cervical expansive laminoplasty due to ossification of the posterior longitudinal ligament of the orthopedic department of Xuzhou Medical University Hospital.The patients including 18 patients with lateral mass screw fixation and 15 patients with Arch plate fixation were followed up in the study.According to different surgical methods,the patients were divided into 2 group.The lateral mass screw group had 18 patients,and arch plate group had 15 patients.The sagittal diameter and opening angle of the C4 segment were compared between the two groups before and after operation,and 6 months after operation.The open angle and open angle loss were measured 3 days after operation and 6 months after operation.The SF-36 quality of life was evaluated before and after the operation,and the activity of the cervical spine was evaluated before and after the follow-up.The postoperative neurological improvement was evaluated by JOA score and improvement rate.The cervical vertebrae X-ray,CT,and MRI were reviewed after operation.The cervical sagittal diameter of C4 segment was measured at 6 months postoperatively.The expansion rate of the spinal canal and the angle of the door opening were evaluated.The condition of bone shaft healing was evaluated.All intraoperative and postoperative complications.Results The follow-up time was 6 to 24 months.Operation time of lateral mass screw group was（143.06±22.44）min,intraoperative blood loss was（256.95±32.23）mL.In arch plate group,operation time was（130.67±21.03）min,and intraoperative blood loss was（238.67±27.02）mL.There was no significant difference between the two groups in the operation time and intraoperative blood loss（P〉0.05）.The JOA score of the lateral mass screw group were（8.39±2.38）beofre operaton and（12.00±2.20）6 months later.The improvement rate of JOA score was（44.16±14.68）%.The JOA score of Arch plate group was（8.53±2.70）before operaton and（14.07±2.31）6 months later.The improvement rate of JOA score was（68.56±15.73）%.There was significant difference in the improvement rate of JOA score between the two groups（P〈0.01）.The sagittal diameter of C4 segmental spinal canal in the lateral mass screw group was（6.20±1.26）mm preoperatively and（10.31±2.15）mm 6 months after operation.The sagittal diameter of C4 segmental arch of Arch plate group was（6.39±1.39）mm preoperatively and（12.43±3.19）mm after 6 months.There was no significant difference in the sagittal diameter of C4 segments between the two groups before operation（P〉0.05）.There were significant differences in the sagittal diameter of C4 segments between the two groups 6 months after operation（P〈0.05）.The angle of vertebral canal opening the lateral mass screw group was（2 5.5 7±3.9 5）°at 6 months after operation,and（29.67±4.16）°for Arch plate group at 6 months after operation.There were significant differences between the two groups in the angle of door opening（P〈0.01）.Patients with open door angle loss were compared,and the difference was statistically significant（P〈0.01）.Two groups of patients were followed up for SF-36 quality of life evaluation,the difference was statistically significant（P〈0.01）.There was significant difference between the two groups in the final follow-up cervical movement evaluation（P〈0.01）.In the lateral mass screw group,there was 1 case of re-closing after operation.5 cases of axial symptoms occurred and relieved after symptomatic treatment.Arch plate group had no reclosing and axial symptoms.Two groups of patients had no internal fixation brending or breakage.The MRI examination showed significant relief of spinal cord compression at 6 months after operation.Conclusion Compared with lateral mass screw fixation,arch plate fixation group’s operation time and intraoperative blood loss were not significantly different in the single open-door cervical expansive laminoplasty.The improvement rate of JOA and spinal canal expansion were better than those of lateral mass screw.Arch plate fixation can effectively avoid axial symptoms and re-closing phenomenon and retain the degree of cervical motion.It is a safe and effective method for the treatment of ossification of the posterior longitudinal ligament of the cervical spine.The early clinical effect is satisfactory.
出处
《实用骨科杂志》
2017年第10期873-878,共6页
Journal of Practical Orthopaedics
关键词
侧块螺钉固定
Arch钛板
颈椎后纵韧带骨化症
疗效分析
lateral mass screw fixation
arch titanium plate
ossification of posterior longitudinal ligament of cervical spine
efficacy analysis
