Centerpiece微型钛板固定与传统丝线悬吊在颈椎后路单开门椎管扩大成形术中的应用效果比较研究

目的:比较Centerpiece微型钛板固定与传统丝线悬吊在颈椎后路单开门椎管扩大成形术中的应用效果。方法:选取于2015年2月～2017年9月期间北京大学第一医院收治的拟行颈椎后路单开门椎管扩大成形术的脊髓型颈椎病患者169例,根据治疗方式的不同将患者分为悬吊组(n=87,给予传统丝线悬吊治疗)和钛板组(n=82,给予Centerpiece微型钛板固定治疗),比较两组手术时间、术中出血量、术后颈椎疼痛时间、术后再关门发生率、轴性症状评分、日本骨科协会量表(JOA)评分、颈椎活动度、颈椎管矢状径、颈椎管横截面积、颈椎曲度、开门角度。结果:两组患者手术时间、术中出血量比较差异无统计学意义(P0.05),钛板组术后颈椎疼痛时间明显短于悬吊组,术后再关门发生率低于悬吊组(P0.05)。两组患者术后2个月、末次随访JOA评分均高于术前,且钛板组高于悬吊组(P0.05),两组患者末次随访轴性症状评分高于术后2个月,且钛板组术后2个月、末次随访轴性症状评分均高于悬吊组(P0.05)。与悬吊组相比,钛板组术后2个月、末次随访颈椎活动度、颈椎管矢状径升高(P0.05);而钛板组术后2个月颈椎管横截面积小于悬吊组,末次随访颈椎管横截面积大于悬吊组(P0.05)。悬吊组末次随访颈椎曲度小于术前、术后2个月(P0.05),钛板组手术前后颈椎曲度比较差异无统计学意义(P0.05);钛板组术后2个月、末次随访颈椎曲度、开门角度均大于悬吊组(P0.05)。结论:颈椎后路单开门椎管扩大成形术中应用Centerpiece微型钛板固定比传统丝线悬吊治疗的临床效果更好,可有效维持患者颈椎功能及活动度,并能改善神经功能。

The Application Effect Comparative Study of Centerpiece Mini-titanium Plate Fixation and Traditional Silk Thread Suspension in Posterior Single-door Laminoplasty for Cervical Vertebral Canal Enlargement

ABSTRACT Objective: To compare the application effect of Centerpiece mini-titanium plate fixation and traditional silk thread suspension in posterior single-door laminoplasty for cervical vertebral canal enlargement. Methods: 169 patients with cervical spondylotic myelopathy who were admitted to the First Hospital of Peking University from February 2015 to September 2017 were selected to undergo posterior single-door laminoplasty for cervical vertebral canal enlargement.The patients were divided into suspension group (n=87, traditional silk thread suspension therapy) and titanium plate group (n=82, Centerpiece mini-titanium plate fixation therapy) according to the different treatment methods. The operation time, intraoperative bleeding volume, post-operative cervical pain time,post-operative reopening rate, axial symptoms score, Japanese Orthopaedic Association (JOA) scale score, cervical mobility, sagittal diameter of cervical spinal canal, cross-sectional area of cervical spinal canal, cervical curvature and opening angle were compared between the two groups. Results: There were no significant differences in operation time and intraoperative bleeding volume between the two groups (P>0.05). The post-operative cervical pain time, in the titanium plate group was significantly shorter than that in the suspension group, and the post-operative reopening rate was lower than that in the suspension group (P<0.05). The JOA scores of the two groups at 2 months after operation and the last follow-up were higher than those before operation, and those of the titanium plate group were higher than those of the suspension group (P<0.05). The axis symptoms score of the last follow-up in two groups was higher than that of 2 months after operation, and the axis symptoms score of the titanium plate group were higher than those of the suspension group at 2 months after operation and the last follow-up (P<0.05). Compared with the suspension group,the cervical mobility, sagittal diameter of cervical spinal canal in the titanium plate group increased at 2 months after operation and the last follow-up (P<0.05). The cross-sectional area of cervical spinal canal in the titanium plate group was smaller than that in the suspension group at 2 months after operation, and the cross-sectional area of cervical spinal canal in the last follow-up was larger than that in the suspension group (P<0.05). The cervical curvature of the last follow-up in the suspension group was less than that before operation and 2 months after operation (P<0.05). There was no significant difference in cervical curvature before and after operation in titanium plate group (P>0.05). The cervical curvature and opening angle of the titanium plate group were greater than those of the suspension group at 2 months after operation and the last follow-up (P<0.05). Conclusion: Centerpiece mini-titanium plate fixation in posterior single-door laminoplasty for cervical vertebral canal enlargement is more effective than traditional silk thread suspension. It can effectively maintain cervical spine function and mobility, and improve nerve function.