Centerpiece微型钛板应用于老年颈椎单开门椎管扩大成形术的疗效分析

Centerpiece titanium miniplate for senile cervical expansive open-door laminoplasty: a retrospective analysis of 27 cases

摘要:

目的 评价应用颈椎单开门Centerpiece内固定椎管扩大成形术治疗老年脊髓型颈椎病的临床效果。方法 回顾性病例对照研究。2009年2月至2010年1月应用颈椎单开门Centerpiece内固定椎管扩大成形术治疗老年脊髓型颈椎病患者27例，年龄平均68.3岁；对照组2008年1月至2008年12月采用传统丝线悬吊颈椎单开门技术治疗该类患者28例，年龄平均67.5岁。以日本骨科协会评估治疗（JOA）评分，术后轴性症状，C5神经瘫以及X线CT测量颈椎曲度、开门角度、有无再关门和固定相关并发症评价手术效果。结果 所有患者术后获得24个月的随访。两组JOA评分改善率差异无统计学意义（51.9% vs 51.8%，P＞0.05）；术后轴性症状评分Centerpiece组显著高于对照组[（10.3±1.3） vs （9.0±1.9），P＜0.05]；Centerpiece组1例、对照组2例患者出现C5神经根麻痹现象，经保守治疗缓解。末次随访时，Centerpiece组颈椎曲度（18.1°±2.4°）与术前（17.9°±2.2°）比较差异无统计学意义（P＞0.05），对照组（15.7°±2.0°）与术前（17.8°±2.4°）比较差异有统计学意义（P＜0.05）；术后及末次随访CT示开门角度维持良好，所有患者均无再关门现象；Centerpiece组1例患者出现椎板侧螺钉松动，无相关症状发生。结论 应用颈椎单开门Centerpiece内固定椎管扩大成形术治疗老年脊髓型颈椎病能够获得良好的临床效果，Centerpiece微型钛板能够很好地减轻术后轴性症状的发生以及颈椎曲度的丢失。

Abstract:

Objective To evaluate the clinical effectiveness of Centerpiece system in cervical expansive open-door laminoplasty in elderly patients. Methods Fifty-five patients with cervical spondylotic myelopathy (CSM) undergoing cervical expansive open-door laminoplasty by Centerpiece mini titanium plate fixation (n＝27, mean age 68.3) from Feb. 2009 to Jan. 2010 or by traditional suture suspension (n＝28, mean age 67.5) from Jan. to Dec. 2008 in Department of Orthopedics, West China Hospital, Sichuan University, were enrolled in this retrospective case-control study. The clinical effectiveness was assessed by Japanese Orthopaedic Association (JOA) score, post-operative axial symptoms, C5 nerve root palsy, value of cervical curvature on X-ray film or CT scan, lamina opened angle, and the reclose of opened laminae. Results All patients were followed up for 24 months. There was no significant difference with regard to the improvement rate of JOA score between two groups (51.9% vs 51.8%, P＞0.05). Centerpiece group had significantly higher score in the postoperative axial symptoms than control group (10.3±1.3 vs 9.0±1.9, P＜0.05). C5 nerve root palsy was seen in one case from Centerpiece group and two cases out of control group, and it was relieved by conservative treatment. No significant difference was found in cervical curvature angle in Centerpiece group before operation and at the final follow-up [(17.9°±2.2°) vs (18.1°±2.4°), P＞0.05)], whereas statistical difference was seen in the control group with the angle larger before operation than that at the final follow-up [(17.8°±2.4°) vs (15.7°±2.0°), P＜0.05)]. CT scanning showed that the angle of the opened laminae was maintained and no reclosed open-laminae was seen at the final follow-up. Screw loosening in the laminae was observed in one case from Centerpiece group, but no relative symptom was found. Conclusion Sound clinical outcome is achieved in the treatment of CSM in elderly patients with cervical expansive open-door laminoplasty with Centerpiece titanium miniplate. The fixation reduces postoperative axial symptoms and prevents the loss of cervical curvature.