摘要
目的评价Vertex钉棒系统在颈椎单开门椎管扩大椎板成形术中临床应用价值及近期疗效。方法 2008年2月-2010年1月,对28例颈椎疾病患者行后路单开门椎管扩大椎板成形术,开门侧应用侧块螺钉(Vertex钉棒系统)固定,对侧掀开椎板用棘突椎板螺钉(Vertex钉棒系统)固定。男16例,女12例;年龄42～77岁,平均61.3岁。脊髓型颈椎病15例,后纵韧带骨化症5例,颈椎病伴椎管狭窄8例。病程2个月～11年。手术开门减压节段均为C3～7。记录手术时间、术中出血量,采用日本骨科协会(JOA)17分法评定神经功能,并进行颈椎曲度及椎板开门角度测量。结果手术时间为(142.5±22.8)min,术中出血量为(288.2±55.1)mL。患者切口均Ⅰ期愈合。28例均获随访,随访时间14～25个月,平均22个月。术后1周及1年CT示所有患者均无再关门现象,钉棒系统位置良好,无松动、拔出和断裂;术后1年门轴侧骨性融合率为89.3%(25/28)。术后1周及1年JOA评分改善率分别为29.5%±15.0%和64.9%±28.1%,差异有统计学意义(t=0.810,P=0.000)。所有患者均未出现C5神经根麻痹现象。术前、术后1周及1年的颈椎曲度分别为(24.29±5.04)、(23.89±3.57)、(23.41±3.35)°,各时间点间比较差异均无统计学意义(P>0.05)。术后1周及1年椎板开门角度分别为(27.90±4.74)°和(28.07±4.21)°,比较差异无统计学意义(t=—0.176,P=0.862)。结论 Vertex钉棒系统可以有效防止单开门椎管扩大椎板成形术后再关门,减少颈椎曲度的丢失,近期疗效满意。
Objective To evaluate the clinical application value and short-term results of Vertex rod-screw system in cervical expansive open-door laminoplasty.Methods Between February 2008 and January 2010,28 patients underwent Vertex rod-screw system fixation in cervical expansive open-door laminoplasty,including 15 cases of cervical spondylotic myelopathy,5 cases of ossification of posterior longitudinal ligament,and 8 cases of cervical spondylosis with spinal stenosis.There were 16 males and 12 females,aged 42-77 years（mean,61.3 years）.The disease duration was 2 months to 11 years.The decompression range of cervical spine was from C3 to C7.The operation time,blood loss,Japanese Orthopedic Association（JOA） scores,and incidence of axial symptom were recorded.Pre-and postoperative curvature angles were demonstrated by the cross angle between posterior vertebral body margins of C2 and C7 on cervical X-ray films.The angle of the opened laminae was measured on CT scan at last follow-up.Results The operation time was（142.5 ± 22.8） minutes,and the blood loss was（288.2 ± 55.1） mL.All incisions healed by first intention.All patients were followed up 14-25 months（mean,22 months）.CT showed that no reclosed open-laminae or loosening and breakage of rod-screw system occurred at 1 week and 1 year after operation.The axial bony fusion rate was 89.3%（25/28）.The improvement rate of JOA scores at 1 week after operation（29.5% ± 15.0%） was significantly smaller than that at 1 year after operation（64.9% ± 28.1%）（t=0.810,P=0.000）.No case presented with C5 nerve root palsy.The cervical curvature angle was（24.29 ± 5.04）° before operation,was（23.89 ± 3.57）° at 1 week,and was（23.41 ± 3.35）° at 1 year after operation,showing no significant difference between pre-and postoperative angles（P 0.05）.The angle of the opened laminae was（27.90 ± 4.74）° at 1 week after operation,and was（28.07 ± 4.21）° at 1 year after operation,showing no significant difference（P 0.05）.Conclusion Vertex rod-screw system in cervical expansive opendoor laminoplasty is effective in preventing reclosed open-laminae,which can reduce the loss of cervical curvature angle.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第12期1440-1444,共5页
Chinese Journal of Reparative and Reconstructive Surgery
