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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第26卷

期數(shù):

2014年12期

頁碼:

19-24

欄目:

臨床研究

出版日期:

2014-12-30

文章信息/Info

Title:

Evaluation of the clinical effect of three kinds of cervical unilateral open-door laminoplasty in posterior access

作者:

衛(wèi)秀洋¹; 陳勇忠¹; 王金星¹; 付桂紅²

1.中國人民解放軍第四七六醫(yī)院,福建 福州 350002;
2.貴州省骨科醫(yī)院,貴州 貴陽 550001

Author(s):

Wei Xiuyang^*

Chen Yongzhong,Wang Jinxing,Fu Guihong.^*The 476th Hospital of PLA,Fuzhou 350002,Fujian,China

關(guān)鍵詞:

頸椎 脊髓壓迫癥 椎間盤移位 后縱韌帶骨化 椎管擴大成形術(shù)

Keywords:

Cervical vertebrae;  Spinal cord compression;  Intervertebral disc displacement;  Ossification of posterior longitudinal ligament;  Laminoplasty

摘要:

目的:觀察3種頸椎后路單開門椎管擴大成形術(shù)的臨床療效和安全性。方法:回顧性分析105例多節(jié)段頸段脊髓受壓患者的 病例資料,采用單開門絲線懸吊椎管擴大成形術(shù)治療者35例(絲線固定組),采用單開門帶線錨釘固定椎管擴大成形術(shù)治療者37例( 錨釘固定組),采用單開門微型鈦板固定椎管擴大成形術(shù)治療者33例(鈦板固定組)。比較3組患者的手術(shù)時間、出血量、住院時間 、JOA評分、最窄椎管面積、頸椎活動度、頸椎曲率指數(shù)及并發(fā)癥發(fā)生情況。結(jié)果:①一般情況。3組患者手術(shù)時間、出血量及住 院時間比較,組間差異均有統(tǒng)計學意義[(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)mL,(364.1±83.2)mL,(436.2±89.4)mL,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]。鈦板固定組手術(shù)時間、出血量大于其余2組 (P=0.000,P=0.000; P=0.000,P=0.000),住院時間比其余2組短(P=0.000,P=0.000); 絲線固定組和錨釘固定組的手術(shù)時間、出血 量及住院時間比較,組間差異均無統(tǒng)計學意義(P=0.326,P=0.824,P=0.536)。②JOA評分。手術(shù)前后不同時間JOA評分的差異有統(tǒng) 計學意義,即存在時間效應(yīng)[(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組患者JOA評分的組 間差異總體上有統(tǒng)計學意義,即存在分組效應(yīng)(F=45.718,P=0.000); 術(shù)前和術(shù)后1周時3組患者JOA評分比較,組間差異均無統(tǒng)計學 意義(F=1.315,P=0.692; F=1.047,P=0.739); 術(shù)后2年時,鈦板固定組評分高于其余2組(P=0.002,P=0.000),其余2組間比較,差異 無統(tǒng)計學意義(P=0.336)。時間因素和分組因素之間不存在交互效應(yīng)(F=0.372,P=1.041)。③最窄椎管面積。手術(shù)前后不同時間 最窄椎管面積的差異有統(tǒng)計學意義,即存在時間效應(yīng)[(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組患者最窄椎管面積的組間差異總體上有統(tǒng)計學意義,即存在分組 效應(yīng)(F=36.342,P=0.000); 術(shù)前和術(shù)后1周時3組患者最窄椎管面積比較,組間差異均無統(tǒng)計學意義(F=6.260,P=0.103; F=4.614,P=0.527); 術(shù)后2年時,鈦板固定組最窄椎管面積大于其余2組(P=0.000,P=0.000),錨釘固定組大于絲線固定組 (P=0.003)。時間因素和分組因素之間不存在交互效應(yīng)(F=1.547,P=0.876)。④頸椎活動度和頸椎曲率指數(shù)。術(shù)前3組患者的頸椎 活動度和頸椎曲率指數(shù)比較,組間差異均無統(tǒng)計學意義[(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]。術(shù) 后2年時3組患者的頸椎活動度和頸椎曲率指數(shù)比較,組間差異均有統(tǒng)計學意義[(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]; 鈦板 固定組的頸椎活動度和頸椎曲率指數(shù)均大于其余2組(P=0.000,P=0.000; P=0.000,P=0.000),其余2組間比較,差異均無統(tǒng)計學意 義(P=0.813,P=0.438)。⑤并發(fā)癥。絲線固定組5例患者術(shù)后早期出現(xiàn)上肢麻木,給予地塞米松后緩解; 錨釘固定組3例患者術(shù)后 發(fā)熱,給予解熱鎮(zhèn)痛藥后緩解; 鈦板固定組2例患者發(fā)生腦脊液漏,3 d后消失。所有患者的手術(shù)切口均甲級愈合,未發(fā)生錨釘脫出 、鈦板松動或斷裂等并發(fā)癥。結(jié)論:3種頸椎后路單開門椎管擴大成形術(shù)均能增加脊髓受壓患者病變部位椎管面積、減小頸椎活 動度和頸椎曲率指數(shù)、改善患者神經(jīng)功能; 與絲線懸吊固定相比,錨釘固定和微型鈦板固定更加牢固,可有效防止再關(guān)門現(xiàn)象; 微型鈦板固定的療效最好,但手術(shù)操作費時、創(chuàng)傷較大。

Abstract:

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 retrospectively.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 statistical difference in JOA scores between the three groups,in other words,there was group effect (F=45.718,P=0.000).There was no statistical 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 statistical difference in ROM of 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 difference in ROM of 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 ROM of 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 symptoms 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 decrease 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.

備注/Memo

備注/Memo:

基金項目:南京軍區(qū)醫(yī)學科技創(chuàng)新課題(11MB028)
通訊作者:陳勇忠 E-mail:[email protected]

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更新日期/Last Update: 2014-12-30