欢迎访问《中国骨伤》杂志社网站！

杂志社公告栏更多>>

本刊继续教育考试系统

下载中心

单开门椎板成形联合单侧侧块螺钉治疗颈椎后纵韧带骨化合并颈椎不稳

摘要点击次数: 725 全文下载次数: 117 投稿时间：2023-12-17

作者	Author	单位	Address	E-Mail
周洋	ZHOU Yang	温州医科大学附属第一医院脊柱外科, 浙江温州 325000	Department of Spine Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
李驰	LI Chi	温州医科大学附属第一医院脊柱外科, 浙江温州 325000	Department of Spine Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
戴王颖	DAI Wang-ying	温州医科大学附属第一医院脊柱外科, 浙江温州 325000	Department of Spine Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
滕红林	TENG Hong-lin	温州医科大学附属第一医院脊柱外科, 浙江温州 325000	Department of Spine Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
朱旻宇	ZHU Min-yu	温州医科大学附属第一医院脊柱外科, 浙江温州 325000	Department of Spine Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
王宇	WANG Yu	温州医科大学附属第一医院脊柱外科, 浙江温州 325000	Department of Spine Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
王靖	WANG Jing	温州医科大学附属第一医院脊柱外科, 浙江温州 325000	Department of Spine Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China	wjspine@163.com

期刊信息：《中国骨伤》2025年，第38卷，第2期，第170-175页

DOI：10.12200/j.issn.1003-0034.20230242

基金项目:

中文摘要:

目的: 探讨颈椎单开门椎板成形(expansive open-door laminoplasty)联合单侧侧块螺钉对颈椎后纵韧带骨化合并颈椎不稳患者的疗效及矢状位平衡影响。

方法: 2012年5月至2018年7月采用颈后路手术治疗的颈椎后纵韧带骨化合并颈椎不稳患者65例,根据手术方法将患者分为两组。单开门椎板成形术组34例,男19例,女15例,年龄49~60(54.4±4.8)岁,病程8~39(21.0±8.2)个月。单开门椎板成形术联合单侧侧块螺钉固定术组31例(单开门联合侧块螺钉组),男17例,女14例,年龄50~59(55.4±3.2)岁,病程7~48(23.7±13.1)个月。比较两组手术时间、术中出血量、术后并发症。观察比较术前和末次随访时在X线片上测量矢状垂直角(sagittal vertical angle,SVA),C₀-C₂ Cobb角和C₂-C₇ Cobb角。使用日本矫形外科学会(Japanese Orthopedic Association,JOA)评分评估临床疗效。

结果: 所有患者手术顺利,单开门联合侧块螺钉组手术时间(109±15) min,长于单开门组(128±16) min,差异有统计学意义(P<0.05)。两组术中出血量、术后轴性症状、随访时间比较,差异均无统计学意义(P>0.05)。末次随访时,两组JOA评分中运动、感觉和总分较术前明显提升(P<0.05);膀胱功能评分无明显变化(P>0.05);而两组间比较差异均无统计学意义(P>0.05)。两组末次随访时C₀-C₂ Cobb角较术前均有增加,单开门组增加的幅度更大(P<0.05);两组C₂-C₇ Cobb角均有减少,单开门联合侧块螺钉组患者减少的幅度更大(P<0.05)。单开门组C₂-C₇ SVA在末次随访时有明显增加(P<0.05),单开门联合侧块螺钉组无明显变化 (P>0.05)。

结论: 颈椎后路单开门椎板成形术联合单侧侧块螺钉内固定改善了颈椎后纵韧带骨化合并颈椎不稳患者的神经功能和生活质量,相比单开门椎板成形术,能改善术后颈椎后凸和前倾。

【关键词】后纵韧带骨化单开门椎板成形术侧块螺钉矢状位平衡

Expansive open-door laminoplasty combined with unilateral lateral mass screw in the treatment of ossification of posterior longitudinal ligament with cervical instability

ABSTRACT

Objective To investigate the effect of expansive open-door laminoplasty combined with single lateral mass screw fixation on the posterior longitudinal ligament ossification and cervical instability and its effect on sagittal balance.

Methods A retrospective analysis of 65 patients with the posterior longitudinal ligament with cervical instability from May 2012 to July 2018 was conducted. The patients were divided into two groups according to the surgical method. Thirty-four patients were treated with open-door laminoplasty including 19 males and 15 females,aged 49 to 60 years old with an average age of (54.4±4.77) years old;symptoms lasted 8 to 39 months with an average of (21.0±8.2) months. Thirty-one patients were treated with single-door laminoplasty combined with single mass screw fixation including 17 males and 14 females,aged 50 to 59 years old with an average age of (55.4±3.2) years;symptoms lasted 7 to 48 months with an average of (23.7±13.1) months. General information of the two groups,including operation time,intraoperative blood loss,and postoperative complications was recorded. Sagittal vertical axis(SVA),C₀-C₂ and C₂-C₇ cobb angle were measured by X-ray before operation and at the last follow-up. Clinical efficacy was evaluated using the Japanese Orthopaedic Association(JOA) score.

Results Surgery was successful in all patients. The operation time (109±15) min in the single-door laminoplasty combined with lateral mass screw fixation group was longer than that in the single-door group(128±16) min(P<0.05). There was no significant difference in intraoperative blood loss,postoperative axial symptoms and follow-up time between two groups(P>0.05). At the latest follow-up,both groups showed significant improvement in the motor and sensory components of the JOA score and the total JOA score compared to pre-surgery(P<0.05) and no significant change in bladder function score(P>0.05). There was no significant difference between two groups(P>0.05). At the latest follow-up,the C₀-C₂ Cobb angle increased in both groups compared to preoperative and more the single-door laminoplasty group(P<0.05). The angle of the C₂-C₇ Cobb angle decreased in both groups,and the reduction was greater in the single-door laminoplasty combined with lateral mass screw fixation group(P<0.05). There was a significant increase in C₂-C₇ SVA in the single-door laminoplasty group(P<0.05) and no significant change the single-door laminoplasty combined with lateral screw fixation group(P>0.05).

Conclusion Posterior cervical laminoplasty with unilateral lateral mass screw fixation combined with single-door vertebral plate shaping surgery improves the neurological function and quality of life in patients with cervical spondylotic myelopathy complicated by ossification of the posterior longitudinal ligament and cervical instability. Compared with single-door vertebral plate shaping surgery,postoperative cervical lordosis and forward-tilt can be improved.

KEY WORDS Ossification of the posterior longitudinal ligament Expansive open-door laminoplasty Lateral msss screw Sagittal balance

引用本文，请按以下格式著录参考文献：

中文格式:	周洋,李驰,戴王颖,滕红林,朱旻宇,王宇,王靖.单开门椎板成形联合单侧侧块螺钉治疗颈椎后纵韧带骨化合并颈椎不稳[J].中国骨伤,2025,38(2):170~175
英文格式:	ZHOU Yang,LI Chi,DAI Wang-ying,TENG Hong-lin,ZHU Min-yu,WANG Yu,WANG Jing.Expansive open-door laminoplasty combined with unilateral lateral mass screw in the treatment of ossification of posterior longitudinal ligament with cervical instability[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(2):170~175

阅读全文下载查看/发表评论下载PDF阅读器

关闭