单开门术中门轴断裂伴椎板移位的处理方式及疗效对比

观察单开门椎管扩大成形术中椎板门轴侧断裂伴移位的处理方式及对术后疗效产生的影响。2013年05月～2018年9月有319例脊髓型颈椎病患者在我院接受单开门椎管成形钛板固定术治疗,其中有63例患者术中发生门轴断裂伴椎板移位,根据处理方式将其分为两组：重建组(35例),对椎板进行叠瓦状重建及钛板固定治疗；切除组(28例),将断裂并移位的椎板切除。记录并比较两组患者术中的相关指标,观察患者神经功能(JOA评分)、颈椎曲度指数(CCI)、颈后肌群横截面积变化及轴性症状的发生情况。在手术时间及术出血量上,两组比较无显著统计学差异(P＞0.05)。术后两组的颈后肌群横截面积较术前均有明显减小(P<0.05),但重建组横截面积减小程度明显低于切除组(P<0.05)。重建组术后CCI获得较好维持(P＞0.05),切除组的CCI较术前出现明显丢失(P＜0.05)；至末次随访时,组间比较有显著统计学差异(P＜0.05)。两组患者JOA评分均有显著升高(P<0.05),组间比较无显著统计学差异(P＞0.05)。术后重建组有8.6%的患者出现轴性症状(3/35),切除组为21.3%(6/28),具有显著统计学差异(P<0.05)。经CT扫描发现,重建组术后3个月时有81.6%(31/38)的节段门轴获得骨性融合,术后6个月时有94.7%(36/38)的节段获得骨性融合。以上结果表明,对门轴断裂伴椎板移位的患者,采用叠瓦状椎板重建联合钛板固定及切除椎板均不会影响术后神经功能的恢复,但椎板重建更有利于颈椎曲度的维持并减轻颈后肌群的萎缩,从而降低轴性症状的发生。

Comparative study of different treatment methods for hinge fracture with laminae displacement in open door laminoplasty

The research was aim to investigate different treatment methods for hinge fracture with laminae displacement in open door laminoplasty and its effect on postoperative efficacy. From May 2013 to September 2018, 319 patients with cervical spondylotic myelopathy were treated with open door laminoplasty in our hospital, among of them, 63 patients occurred hinge fracture with laminae displacement. Patients were divided into two groups according to the treatment methods. Reconstruction group (35 cases) accepted imbricate reconstruction combined with titanium plate fixation, and resection group (28 cases) accepted lamina resection. The intraoperative indicators were recorded and compared. The neurological function (JOA score), cervical curvature index (CCI), cross sectional area of posterior cervical muscles and axial symptoms were observed. There was no significant difference in terms of operative time and bleeding volume between the two groups (P> 0.05). The cross-sectional area of the posterior cervical muscles in both groups was significantly reduced compared with the preoperative level (P <0.05), but the decline degree in reconstruction group was significantly lower than that in the resection group (P <0.05). The CCI in the reconstruction group was maintained well after surgery (P> 0.05), but in resection group, it was significantly lost (P <0.05). The JOA scores in both groups was significantly increased after surgery (P <0.05), and there was no significant difference between the groups at different time point (P> 0.05). The occurrence of axial symptoms was 8.6% (3/35) in reconstruction group and 21.3% (6/28) in resection group (P <0.05). The hinge fusion rate at 3 and 6 months after surgery was 81.6% (31/38) and 94.7% (36/38), respectively. For patients with hinge fracture and laminar displacement, imbricate reconstruction combined with titanium plate fixation will not affect the recovery of neurological function, but hinge reconstruction is more conducive to the maintain the cervical curvature and reduce the atrophy of the posterior muscles, thereby reducing the occurrence of axial symptoms.