两种后路内固定结合单开门手术治疗多节段脊髓型颈椎病的近期疗效比较

目的比较后路颈椎板成形术钉棒固定与微型钛板固定治疗多节段脊髓型颈椎病的近期疗效。方法将47例多节段脊髓型颈椎病患者随机分为两组:23例行后路颈椎板成形微型钛板固定术(微型钛板组),24例行后路颈椎板成形钉棒固定术(钉棒组)。比较两组手术时间、术中出血量、JOA评分、VAS评分、术后椎管矢状径、颈椎曲度、术后活动度影响及手术并发症等,评价两种手术方式的临床疗效。结果患者均获得随访,微型钛板组为(23.8±8.1)个月,钉棒组为(23.6±8.0)个月。两组手术时间、术中出血量、手术并发症比较差异无统计学意义(P0.05)。JOA评分:两组手术后均较术前显著升高(P0.05),两组间比较差异无统计学意义(P0.05)。颈痛VAS评分:术前钉棒组显著高于微型钛板组(P0.05),术后两组评分均较术前显著降低(P0.05),两组间比较差异无统计学意义(P0.05)。颈椎矢状径:两组术后3 d和未次随访时均较术前明显改善(P0.05),两组间比较差异无统计学意义(P0.05)。术后3 d和末次随访时微型钛板组颈椎曲度改善明显优于钉棒组(P0.05)。末次随访时两组活动度均较术前减少(P0.05),钉棒组减少的度数明显大于微型钛板组(P0.05)。结论后路颈椎板成形术钉棒固定与微型钛板固定治疗多节段脊髓颈椎病神经功能改善相似,微型钛板对颈椎的活动度影响较少。

Comparison of short-term effect of two kinds of posterior internal fixation combined with ex-pansive open-door laminoplasty in the treatment of multilevel cervical myelopathy

Objective To compare the short-term clinical effect of posterior vertebral plate internal fixation combined with expansive open-door laminoplasty and posterior screw rod system fixation combined with expansive open -door laminoplasty in the treatment of multilevel cervical myelopathy .Methods Forty-seven cases with cervical spondylot-ic myelopathy were randomly divided into two groups:23 cases underwent posterior cervical laminoplasty with mini ti-tanium plate fixation ( titanium mini plate fixation group ) , 24 cases underwent angioplasty of posterior cervical plate (screw rod group).Two groups of operation time, intraoperative bleeding, JOA score, VAS, postoperative spinal sag-ittal diameter and curvature of cervical vertebrae , postoperative activity effect and complication were compared , the clinical curative effect of two operation methods were evaluated .Results The patients were followed up ,with mini ti-tanium plate group was (23.8 ±8.1) months, screw rod group was (23.6 ±8.0) months.The operative time, vol-ume of bleeding , complications in the two groups had no significant difference ( P>0.05 ) .The JOA scores of the two groups after operation were significantly higher than that before operation ( P<0.05 ) , there was no significant difference between the two groups (P>0.05).Preoperative neck pain VAS:screw rod group was significantly higher than that of titanium mini plate group (P<0.05), postoperative scores of the two groups were significantly decreased (P<0.05), but there was no significant difference between the two groups (P>0.05).Two groups of postoperative 3 d and follow-up cervical sagittal diameter were significantly improved compared with the preoperative ( P<0.05 ) , there was no significant difference between the two groups (P>0.05).Three days after operation and at the end of the follow-up, mini titanium plate group was significantly better than the curvature of cervical screw rod group ( P<0.05).At the end of the follow-up, activities of two groups were less than the preoperative (P<0.05), screw rod group to reduce the degree was significantly greater than the mini titanium plate (P<0.05).Conclusions Posterior cervical spine plate fixation for the treatment of multi segmental cervical spondylosis of nerve function improvement is similar to that of mini titanium plate fixation ,the cervical vertebrae activity is less affected by micro titanium plate .