微型鋼板側塊螺釘穿透小關節面對頸椎單開門術后軸性癥狀的影響_《中國修復重建外科雜志》

作者：

陳華 , 劉浩 , 李濤 , 龔全 , 宋躍明 , 曾建成 , 劉立岷 , 孔清泉

四川大學華西醫院骨科（成都，610041）;

關鍵詞：

頸椎單開門椎管擴大椎板成形術 Centerpiece鋼板側塊螺釘軸性癥狀

DOI：

10.7507/1002-1892.20130289

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目的探討頸椎單開門椎管擴大椎板成形Centerpiece內固定術中側塊螺釘穿透小關節面對術后軸性癥狀的影響。方法回顧分析2009年9月－2011年12月接受后路C3～7單開門椎管擴大椎板成形Centerpiece內固定術且符合選擇標準的52例患者臨床資料。男42例，女10例；年齡34～83歲，平均61.2歲。單純退行性頸椎管狹窄癥17例，合并多節段頸椎間盤突出癥25例，合并后縱韌帶骨化癥10例。病程1～120個月，中位病程11個月。采用日本骨科協會（JOA）評分法評價患者神經功能，計算神經功能改善率；疼痛視覺模擬評分（VAS）及頸椎功能障礙指數（NDI）評估患者頸肩部疼痛及頸椎功能情況。記錄患者術后軸性癥狀及其他并發癥發生情況。行頸椎X線片、CT及MRI檢查，測量椎管矢狀徑、頸椎曲度、椎管橫截面積、椎板開門角度。通過術后1周CT三維重建判斷Centerpiece鋼板側塊螺釘是否穿透小關節面進入小關節，并根據破壞的小關節數量將患者分為無關節破壞組（無小關節面被穿透）、少關節破壞組（1～2 個小關節面被穿透）和多關節破壞組（3個及以上小關節面被穿透），對各組以上指標進行統計分析。結果術后5例發生C5神經根麻痹，2例腦脊液漏，均經相應治療后治愈。患者均獲隨訪，隨訪時間3～35個月，平均15.7個月。末次隨訪時，患者JOA評分、NDI、椎管矢狀徑以及椎管橫截面積均優于術前（P lt; 0.05）。根據術后1周CT三維重建檢查，無關節破壞組16例，少關節破壞組23例，多關節破壞組13例；3組患者年齡、性別、病程、手術時間、術中出血量及隨訪時間比較，差異均無統計學意義（P gt; 0.05），具有可比性。末次隨訪時，3組術后JOA評分、VAS評分，頸椎曲度、椎管矢狀徑、椎管橫截面積以及神經功能改善率、開門角度比較，差異均無統計學意義（P gt; 0.05）；但3組間NDI比較差異有統計學意義（P lt; 0.05）。術后10例發生軸性癥狀，無關節破壞組1例，少關節破壞組4例，多關節破壞組5例，3組間軸性癥狀發生率比較差異無統計學意義（χ2=4.881，P=0.087）。結論側塊螺釘穿透小關節面可能是單開門椎管擴大椎板成形Centerpiece內固定術后出現軸性癥狀的原因之一，且隨著小關節面破壞數目的增加，發生軸性癥狀的風險可能增加。

引用本文： 陳華,劉浩,李濤,龔全,宋躍明,曾建成,劉立岷,孔清泉. 微型鋼板側塊螺釘穿透小關節面對頸椎單開門術后軸性癥狀的影響. 中國修復重建外科雜志, 2013, 27(11): 1324-1330. doi: 10.7507/1002-1892.20130289 復制

1.	幸嶸, 孔清泉. 頸椎后路椎管擴大成形術后并發癥的研究進展. 中國修復重建外科雜志, 2012, 26(3): 284-288.
2.	Umeda M, Sasai K, Kushida T, et al. A less-invasive cervical laminoplasty for spondylotic myelopathy that preserves the semispinalis cervicis muscles and nuchal ligament. J Neurosurg Spine, 2013, 18(6): 545-552.
3.	曾云, 熊敏, 余化龍, 等. 微型鋼板與錨定法在單開門頸椎管擴大成形術中應用的對比研究. 中國修復重建外科雜志, 2011, 25(8): 946-950.
4.	Rhee JM, Register B, Hamasaki T, et al. Plate-only open door laminoplasty maintains stable spinal canal expansion with high rates of hinge union and no plate failures. Spine (Phila Pa 1976), 2010, 36(1): 9-14.
5.	陳華, 劉浩, 林書, 等. Centerpiece鋼板應用于頸椎后路單開門椎板成形術的臨床效果觀察. 生物骨科材料與臨床研究, 2012, 9(6): 12-15.
6.	黃袁遲, 鄒德威, 馬華松, 等. 頸椎小關節的形態學研究進展. 中國脊柱脊髓雜志, 2011, 21(12): 1026-1029.
7.	Yonenobu K, Abumi K, Nagata K, et al. Interobserver and intraobserver reliability of the Japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976), 2001, 26(17): 1890-1894.
8.	潘勝發, 孫宇, 朱振軍, 等. 單開門頸椎管擴大椎板成形術后軸性癥狀與頸椎穩定性的相關觀察. 中國脊柱脊髓雜志, 2003, 13(10): 604-607.
9.	Ahn JS, Lee JK, Kim BK. Prognostic factors that affect the surgical outcome of the laminoplasty in cervical spondylotic myelopathy. Clin Orthop Surg, 2010, 2(2): 98-104.
10.	李雷, 王歡, 崔少千, 等. 重建后方韌帶復合體的頸椎單開門橋式植骨椎板成形術對術后軸性癥狀和頸椎曲度的影響. 中國修復重建外科雜志, 2007, 21(5): 457-460.
11.	劉曉偉, 陳德玉, 王波, 等. C3～C7與C3～C6節段單開門椎管擴大成形術后軸性痛的差異. 中國脊柱脊髓雜志, 2012, 22(11): 989-993.
12.	Kato M, Nakamura H, Konishi S, et al. Effect of preserving paraspinal muscles on postoperative axial pain in the selective cervical laminoplasty. Spine (Phila Pa 1976), 2008, 33(14): E455-E459.
13.	Sakaura H, Hosono N, Mukai Y, et al. Preservation of muscles attached to the C2 and C7 spinous processes rather than subaxial deep extensors reduces adverse effects after cervical laminoplasty. Spine (Phila Pa 1976), 2010, 35(16): E782-786.
14.	Yang L, Gu Y, Shi J, et al. Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy. Orthopedics, 2013, 36(1): e79-87.
15.	Fujibayashi S, Neo M, Yoshida M, et al. Neck muscle strength before and after cervical laminoplasty: relation to axial symptoms. J Spinal Disord Tech, 2010, 23(3): 197-202.
16.	Ono A, Tonosaki Y, Numasawa T, et al. The relationship between the anatomy of the nuchal ligament and postoperative axial pain after cervical laminoplasty: cadaver and clinical study. Spine (Phila Pa 1976), 2012, 37(26): E1607-1613.
17.	Schneider GM, Jull G, Thomas K, et al. Intrarater and interrater reliability of select clinical tests in patients referred for diagnostic facet joint blocks in the cervical spine. Arch Phys Med Rehabil, 2013, 94(8): 1628-1634.
18.	孫宇, 張鳳山, 潘勝發, 等. “錨定法”改良單開門椎管成形術及其臨床應用. 中國脊柱脊髓雜志, 2004, 14(9): 517-519.
19.	Hyun SJ, Riew KD, Rhim SC. Range of motion loss after cervical laminoplasty: a prospective study with minimum 5-year follow-up data. Spine J, 2013, 13(4): 384-390.
20.	O’Brien MF, Peterson D, Casey AT, et al. A novel technique for laminoplasty augmentation of spinal canal area using titanium miniplate stabilization. A computerized morphometric analysis. Spine (Phila Pa 1976), 1996, 21(4): 474-484.
21.	Park AE, Heller JG. Cervical laminoplasty: use of a novel titanium plate to maintain canal expansion—surgical technique. J Spinal Disord Tech, 2004, 17(4): 265-271.

1. 幸嶸, 孔清泉. 頸椎后路椎管擴大成形術后并發癥的研究進展. 中國修復重建外科雜志, 2012, 26(3): 284-288.
2. Umeda M, Sasai K, Kushida T, et al. A less-invasive cervical laminoplasty for spondylotic myelopathy that preserves the semispinalis cervicis muscles and nuchal ligament. J Neurosurg Spine, 2013, 18(6): 545-552.
3. 曾云, 熊敏, 余化龍, 等. 微型鋼板與錨定法在單開門頸椎管擴大成形術中應用的對比研究. 中國修復重建外科雜志, 2011, 25(8): 946-950.
4. Rhee JM, Register B, Hamasaki T, et al. Plate-only open door laminoplasty maintains stable spinal canal expansion with high rates of hinge union and no plate failures. Spine (Phila Pa 1976), 2010, 36(1): 9-14.
5. 陳華, 劉浩, 林書, 等. Centerpiece鋼板應用于頸椎后路單開門椎板成形術的臨床效果觀察. 生物骨科材料與臨床研究, 2012, 9(6): 12-15.
6. 黃袁遲, 鄒德威, 馬華松, 等. 頸椎小關節的形態學研究進展. 中國脊柱脊髓雜志, 2011, 21(12): 1026-1029.
7. Yonenobu K, Abumi K, Nagata K, et al. Interobserver and intraobserver reliability of the Japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976), 2001, 26(17): 1890-1894.
8. 潘勝發, 孫宇, 朱振軍, 等. 單開門頸椎管擴大椎板成形術后軸性癥狀與頸椎穩定性的相關觀察. 中國脊柱脊髓雜志, 2003, 13(10): 604-607.
9. Ahn JS, Lee JK, Kim BK. Prognostic factors that affect the surgical outcome of the laminoplasty in cervical spondylotic myelopathy. Clin Orthop Surg, 2010, 2(2): 98-104.
10. 李雷, 王歡, 崔少千, 等. 重建后方韌帶復合體的頸椎單開門橋式植骨椎板成形術對術后軸性癥狀和頸椎曲度的影響. 中國修復重建外科雜志, 2007, 21(5): 457-460.
11. 劉曉偉, 陳德玉, 王波, 等. C3～C7與C3～C6節段單開門椎管擴大成形術后軸性痛的差異. 中國脊柱脊髓雜志, 2012, 22(11): 989-993.
12. Kato M, Nakamura H, Konishi S, et al. Effect of preserving paraspinal muscles on postoperative axial pain in the selective cervical laminoplasty. Spine (Phila Pa 1976), 2008, 33(14): E455-E459.
13. Sakaura H, Hosono N, Mukai Y, et al. Preservation of muscles attached to the C2 and C7 spinous processes rather than subaxial deep extensors reduces adverse effects after cervical laminoplasty. Spine (Phila Pa 1976), 2010, 35(16): E782-786.
14. Yang L, Gu Y, Shi J, et al. Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy. Orthopedics, 2013, 36(1): e79-87.
15. Fujibayashi S, Neo M, Yoshida M, et al. Neck muscle strength before and after cervical laminoplasty: relation to axial symptoms. J Spinal Disord Tech, 2010, 23(3): 197-202.
16. Ono A, Tonosaki Y, Numasawa T, et al. The relationship between the anatomy of the nuchal ligament and postoperative axial pain after cervical laminoplasty: cadaver and clinical study. Spine (Phila Pa 1976), 2012, 37(26): E1607-1613.
17. Schneider GM, Jull G, Thomas K, et al. Intrarater and interrater reliability of select clinical tests in patients referred for diagnostic facet joint blocks in the cervical spine. Arch Phys Med Rehabil, 2013, 94(8): 1628-1634.
18. 孫宇, 張鳳山, 潘勝發, 等. “錨定法”改良單開門椎管成形術及其臨床應用. 中國脊柱脊髓雜志, 2004, 14(9): 517-519.
19. Hyun SJ, Riew KD, Rhim SC. Range of motion loss after cervical laminoplasty: a prospective study with minimum 5-year follow-up data. Spine J, 2013, 13(4): 384-390.
20. O’Brien MF, Peterson D, Casey AT, et al. A novel technique for laminoplasty augmentation of spinal canal area using titanium miniplate stabilization. A computerized morphometric analysis. Spine (Phila Pa 1976), 1996, 21(4): 474-484.
21. Park AE, Heller JG. Cervical laminoplasty: use of a novel titanium plate to maintain canal expansion—surgical technique. J Spinal Disord Tech, 2004, 17(4): 265-271.

《中國修復重建外科雜志》

微型鋼板側塊螺釘穿透小關節面對頸椎單開門術后軸性癥狀的影響

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《中國修復重建外科雜志》

微型鋼板側塊螺釘穿透小關節面對頸椎單開門術后軸性癥狀的影響

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