Cheng Zhaohui, Chen Weishan, Yan Shigui, Li Wanli, Qian Shengjun
From the Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, People's Republic of China.
Medicine (Baltimore). 2015 Jul;94(28):e1171. doi: 10.1097/MD.0000000000001171.
Retrospective cohort study. To evaluate efficacy and relevant problems of in situ reconstruction of extensor muscle insertion on the C2 spinous process combined with titanium miniplates internal fixation in expansive open-door cervical laminoplasty in order to improve surgical treatment effect. Expansive open-door cervical laminoplasty has been widely applied in clinical practice, but there are a series of postoperative problems. Therefore, decreasing postoperative complications in order to more effectively relieve symptoms remains a subject for additional research. From October 2011 to September 2013, a total of 60 patients who suffered cervical canal stenosis were treated by expansive open-door laminoplasty with in situ reconstruction of extensor muscle insertion on the C2 spinous process combined with titanium miniplates internal fixation. Changes of cervical curvature index (CI) and range of motion (ROM) were calculated using data from preoperative and postoperative cervical spine X-ray examinations. Clinical function was scored using the Japanese Orthopedics Association Scoring System (JOA) and the neck disability index (NDI). The mean CI before the operation and at 1-year postoperation were 10.49% ± 3.93% and 14.14 ± 2.85 (P < 0.05). The mean ROM values were 43.35 ± 7.55 before the operation, 34.83 ± 7.41 at 1-year postoperation (P < 0.05). The NDI scores decreased from 19.42 ± 4.12 to 7.37 ± 2.58, and the JOA scores increased from 8.87 ± 1.99 to 13.55 ± 1.72, representing significant improvement (P < 0.05). One patient had postoperative C5 nerve root palsy and completely recovered 1 month later. Neither collapse nor door closure in the open-door side occurred in any of the patients. Expansive open-door cervical laminoplasty with in situ reconstruction of extensor muscle insertion on the C2 spinous process combined with titanium miniplates internal fixation is a safe and effective surgical method, and can effectively decrease postoperative complications and achieve satisfactory clinical results.
回顾性队列研究。为评估C2棘突上伸肌止点原位重建联合微型钛板内固定在扩大开门式颈椎椎板成形术中的疗效及相关问题，以提高手术治疗效果。扩大开门式颈椎椎板成形术已在临床广泛应用，但存在一系列术后问题。因此，减少术后并发症以更有效地缓解症状仍是有待进一步研究的课题。2011年10月至2013年9月，共有60例颈椎管狭窄患者接受了扩大开门式椎板成形术，术中进行C2棘突上伸肌止点原位重建并联合微型钛板内固定。利用术前和术后颈椎X线检查数据计算颈椎曲度指数（CI）和活动度（ROM）的变化。采用日本骨科协会评分系统（JOA）和颈部功能障碍指数（NDI）对临床功能进行评分。术前和术后1年的平均CI分别为10.49%±3.93%和14.14±2.85（P<0.05）。术前平均ROM值为43.35±7.55，术后1年为34.83±7.41（P<0.05）。NDI评分从19.42±4.12降至7.37±2.58，JOA评分从8.87±1.99升至13.55±1.72，均有显著改善（P<0.05）。1例患者术后出现C5神经根麻痹，1个月后完全恢复。所有患者均未出现开门侧塌陷或关门现象。C2棘突上伸肌止点原位重建联合微型钛板内固定的扩大开门式颈椎椎板成形术是一种安全有效的手术方法，可有效减少术后并发症并取得满意的临床效果。
