颈椎椎弓根螺钉固定联合椎板成形术治疗不稳定性脊髓型颈椎病
谢守宁;韩生寿;李洪;
摘要(Abstract)：
[目的]探讨颈椎椎弓根螺钉(cervical pedicle screw,CPS)内固定联合椎板成形术治疗不稳定性脊髓型颈椎病(cervical spondylotic myelopathy,CSM)的临床疗效和放射学结果。[方法]选取本院2002年2月～2011年2月采用颈椎椎弓根螺钉内固定联合椎板成形术治疗不稳定性CSM并获得随访的患者25例,男18例,女7例;平均年龄(63.5±7.2)岁。平均随访时间(31.6±25.6)个月。临床评估:评估术前、术后即刻和末次随访时JOA评分,并计算神经功能改善率;颈椎轴性症状(AS)的评价根据曾岩等提出的标准。影像学评估:测量术前、术后C2～7夹角和颈椎活动度(ROM);测量术前、术后不稳定节段水平移位的百分比和相邻椎体间活动度的变化。所有患者术后行CT检查,检查螺钉的位置。[结果]平均JOA评分由术前(8.7±3.1)分提高到末次随访时的(13.7±3.1)分(P=0.007);末次随访时AS发生率为20%;神经功能改善率66.9%。平均C2～7夹角由术前(12.6±3.3)°下降到末次随访时的(10.9±2.3)°(P=0.032)。平均ROM由术前的(35.2±11.2)°下降到末次随访时的(12.3±7.5)°(P=0.039)。平均不稳定节段水平移位在中立位时百分比由术前(8.2±12.3)%改善到末次随访时的(3.1±4.5)%(P=0.012)。平均相邻椎体间活动度由术前的(13.0±2.5)°改善为末次随访时的(1.5±1.1)°(P=0.008)。术后行CT检查螺钉位置,其中3级螺钉穿透率为6.6%。[结论]后路CPS内固定联合椎板成形术是治疗不稳定性CSM的一种有效方法,可以取得满意的临床疗效和放射学结果。
关键词(KeyWords)： 脊髓型颈椎病;不稳定;椎板成形术;椎弓根螺钉;内固定
基金项目(Foundation):
作者(Author): 谢守宁;韩生寿;李洪;
Email:
DOI:
参考文献(References)：
- [1]Toledano M,Bartleson JD.Cervical spondylotic myelopathy[J].Neurol Clin,2013,1:287-305.
- [2]White AA,Panjabi MM.Update on the evaluation of instability of thelower cervical spine[J],Instr Course Lect,1987,36:513-520.
- [3]曾岩,党耕町,马庆军.颈椎前路融合术后颈部运动功能的评价[J].中华外科杂志,2004,24:1481-1484.
- [4]Uehara M,Takahashi J,Ogihara N,et al.Cervical pedicle screwfixation combined with laminoplasty for cervical spondylotic myelopa-thy with instability[J].Asian Spine J,2012,4:241-248.
- [5]Yoshimoto H,Sato S,Hyakumachi T,et al.Clinical accuracy ofcervical pedicle screw insertion using lateral fluoroscopy:a radio-graphic analysis of the learning curve[J].Eur Spine J,2009,9:1326-1334.
- [6]胡晓春,张兴祥,周志平.脊髓型颈椎病前路减压手术70例疗效评价[J].实用骨科杂志,2012,10:915-917.
- [7]Chen HC,Chang MC,Yu WK,et al.Lateral mass anchoring screwsfor cervical laminoplasty:preliminary report of a novel technique[J].J Spinal Disord Tech,2008,6:387-392.
- [8]Liu Y,Hu JH,Yu KY.Pedicle screw fixation for cervical spine in-stability:clinical efficacy and safety analysis[J].Chin Med J(En-gl),2009,17:1985-1989.
- [9]Cabraja M,Abbushi A,Koeppen D,et al.Comparison between an-terior and posterior decompression with instrumentation for cervicalspondylotic myelopathy:sagittal alignment and clinical outcome[J].Neurosurg Focus,2010,3:15.
- [10]胡加绍,张益俊.椎弓根螺钉技术治疗颈椎骨折脱位[J].中华创伤骨科杂志,2012,3:268-269.
- [11]Yuzawa Y,Kamimura M,Nakagawa H,et al.Surgical treatmentwith instrumentation for severely destructive spondyloarthropathy ofcervical spine[J].J Spinal Disord Tech,2005,1:23-28.
- [12]Yukawa Y,Kato F,Ito K,et al.Placement and complications ofcervical pedicle screws in 144 cervical trauma patients using pedicleaxis view techniques by fluoroscope[J].Eur Spine J,2009,9:1293-1299.