颈椎后路单开门椎管扩大成形侧块螺钉内固定术治疗老年颈椎管狭窄症的临床效果观察

Clinical Effect of Posterior Cervical Open-door Expansive Laminoplasty with Lateral Mass Screw Fixation on Elderly Cervical Spinal Stenosis

中文关键词: 老年  颈椎管狭窄症  颈椎后路  单开门  椎管扩大成形术  内固定术  侧块螺钉

英文关键词: elderly  cervical spinal stenosis  open-door laminoplasty  internal fixation  lateral mass screw

中文摘要:

      目的 探讨颈椎后路单开门椎管扩大成形侧块螺钉内固定术治疗老年颈椎管狭窄症患者的临床效果.方法 完整收集37例老年颈椎管狭窄症患者的临床资料予以回顾性分析研究,均行颈椎后路单开门椎管扩大成形侧块螺钉内固定术治疗.观察统计患者的手术情况、不同时间的视觉模拟评分量表(VAS)与颈椎残障功能量表(NDI)等评分情况,统计并发症发生情况.结果 37例患者均顺利完成手术治疗,平均手术时间为(116±26) min,术中平均出血量为(468±45) mL.与术前比较,术后3个月和6个月患者的VAS评分、NDI评分以及JOA评分均表现出明显的改善,其中VAS评分和NDI评分水平均显著下降(均P＜0.05),而JOA评分显著上升(P＜0.05).手术过程中所有患者均顺利置入螺钉,未出现神经血管损伤等情况,术后2例患者出现颈5神经根麻痹,经积极的营养神经治疗和脱水、激素等治疗,症状逐渐消失,最终的并发症发生率为5.41％.结论 颈椎后路单开门椎管扩大成形侧块螺钉内固定术治疗老年颈椎管狭窄症可以获得理想的临床效果,有效改善患者的临床症状和日常功能状态,且并发症轻微,是一种安全有效的治疗方案.

英文摘要:

      Objective To explore the clinical effect of posterior cervical open-door expansive laminoplasty with lateral mass screw fixation on elderly cervical spinal stenosis.Methods A retrospective analysis was made to the clinical data of 37 elderly with cervical spinal stenosis treated by posterior cervical open-door expansive laminoplasty with lateral mass screw fixation;the surgical treatment,VAS scores at different time points,NDI scores and the occurrence of complications were statistically studied.Results Surgical success was gained in all the 37 patients;the average length of operation during was (116±26) minutes and the average volume of bleeding in operation was (468±45) mL;the VAS scores and NDI scores of the patients at the time points of 3 months and 6 months after operation were much lower than those before operation (P＜0.05) while JOA scores were much higher than those before operation (P＜0.05);no neurovascular injury occurred;palsy of the C_5 nerve root was found in 2 patients and the symptoms disappeared after related trcatment;the final occurrence of complications was 5.41％.Conclusions Posterior cervical open-door expansive laminoplasty with lateral mass screw fixation is of good clinical effect on the elderly with cervical spinal stenosis,it leads to greater improvement of clinical symptoms and daily living but less complications.