Chen Guangdong, Luo Zongping, Nalajala Badri, Liu Tao, Yang Huilin
Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
Orthopedics. 2012 Apr;35(4):e543-8. doi: 10.3928/01477447-20120327-24.
Expansive laminoplasty is an effective treatment for cervical myelopathy. Since the design of classic open-door laminoplasty with the use of suture, the procedure has been modified to reduce complications such as restenosis, axial symptoms, and segmental motor paralysis. Expansive open-door laminoplasty with the use of titanium miniplate is becoming popular. It is effective in expanding spinal canal dimensions with good clinical efficacy. However, a lack of studies exist comparing titanium miniplate fixation with classical suture fixation.We performed a retrospective study of 54 patients with cervical myelopathy. Twenty-nine patients (4 women and 25 men) receiving expansive open-door laminoplasty by titanium miniplate fixation were classified as the modified group, and 25 patients (5 women and 20 men) fixed with suture served as the control group. Clinical and radiologic outcomes were assessed. No significant differences were observed in Japanese Orthopaedic Association scores and the recovery rate of C5 palsy. The incidence of axial symptoms in the modified group was significantly lower than that in control group. Radiologic examination showed that postoperative C2-C7 lordosis and range of motion of the cervical spine in the modified group were preserved. No significant differences were observed in mean anteroposterior diameter and open angle in the 2 groups. Both surgical protocols were effective in preventing reclosure of open laminae. Furthermore, the modified laminoplasty was superior in reducing the incidence of axial symptoms and loss of cervical lordosis and range of motion.
扩大椎板成形术是治疗脊髓型颈椎病的一种有效方法。自从经典的使用缝线的开门式椎板成形术设计以来，该手术已被改良以减少诸如再狭窄、轴性症状和节段性运动麻痹等并发症。使用钛微型钢板的扩大开门式椎板成形术正变得流行起来。它在扩大椎管尺寸方面有效且临床疗效良好。然而，缺乏比较钛微型钢板固定与经典缝线固定的研究。
我们对54例脊髓型颈椎病患者进行了一项回顾性研究。29例（4例女性和25例男性）接受钛微型钢板固定的扩大开门式椎板成形术的患者被归类为改良组，25例（5例女性和20例男性）采用缝线固定的患者作为对照组。评估了临床和影像学结果。日本骨科协会评分和C5麻痹恢复率方面未观察到显著差异。改良组的轴性症状发生率显著低于对照组。影像学检查显示改良组术后C2 - C7前凸和颈椎活动度得以保留。两组在平均前后径和开门角度方面未观察到显著差异。两种手术方案在防止椎板再闭合方面均有效。此外，改良椎板成形术在降低轴性症状发生率以及颈椎前凸和活动度丧失方面更具优势。
