Xu X N, Liu H Y
Department of Spinal Surgery, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Wai Ke Za Zhi. 2017 Mar 1;55(3):214-219. doi: 10.3760/cma.j.issn.0529-5815.2017.03.010.
To evaluate the clinical effect and imaging evaluation of cervical spine myelopathy treated with Centerpiece. A retrospective study of 60 patients underwent posterior cervical spine surgery because of cervical myelopathy in Spinal Department of Peking University People's Hospital from July 2011 to January 2013.According to the different fixation methods, all patients were divided into cervical posterior open-door Centerpiece fixation group (group A) and cervical posterior open-door silk suspension fixation group (group B). There were 40 patients in group A, including 25 males and 15 females, mean age (59.7±11.9) years old, average course of disease before surgery (53.6±61.5) months, average follow-up time (28.5±3.1) months after operation.There were 20 patients in group B, including 15 males and 5 females, mean age (58.3±9.6) years old, average course of disease before surgery (50.4±14.9) months, average follow-up time (28.3±1.9) months after operation.The operation time, intraoperative blood loss, postoperative drainage, preoperative and postoperative Japanese Orthopaedic Association(JOA) score, the neck disability index(NDI) score, visual analog scale (VAS) score, postoperative axial pain, C(5) nerve root palsy, postoperative "re-closing" and other related complications were observed.Imaging assessment projects include: before and after surgery of cervical curvature, range of motion(ROM), spinal anteroposterior diameter, spinal canal expansion rate, the whole spinal cord backward shift distance and area of the spinal canal and the opening angle. There was no significant difference in general data between the two groups (>0.05). Group A the average operation time was(117.7±23.4)min, the average amount of operative bleeding was (152.0±122.7) ml, and the postoperative drainage volume was (268.7±222.1) ml.The average operation time of group B was (141.7±23.9) min, the average amount of operative bleeding was (166.7±42.5) ml, and the postoperative drainage volume of group B was (255.3±47.0) ml.There was no significant difference between the two groups in the amount of operative bleeding and postoperative drainage volume (both >0.05), the operation time between the two groups was statistically significant (<0.05). At the end of the follow-up, the JOA score, NDI score, and VAS score were significantly improved (<0.05) in both group A and group B and there was no significant difference between the two groups (>0.05). C(5) nerve root paralysis was not occurred in both two groups after operation.There were 1 case of axial pain in the group A and 7 cases in the group B and there were significant differences between the two groups (<0.05). The group A was not found "re-closing" during the follow-up and 12 patients of group B found to be "re-closing" phenomenon, there were statistically different between the two groups (<0.05). Comparison of preoperative and postoperative, there were no significant differences in cervical curvature and ROM in both groups (>0.05). Butthe spinal canal diameter and the vertebral canal area were statistically different after surgery (<0.05). There was no statistical difference between the two groups of cervical curvature and ROM (>0.05). There was no statistical difference between the two groups of spinal canal diameter, spinal canal area and spinal canal diameter enlargement rate(>0.05). There was no statistical difference between the two groups of the whole spinal cord backward shift distance(>0.05). There were significant differences between the two groups at the angle of the open door (<0.05). Centerpiece cervical posterior titanium plate can achieve good clinical efficacy in the treatment of multi segmental spinal cervical spondylosis.
评估Centerpiece治疗脊髓型颈椎病的临床疗效及影像学评估。回顾性研究2011年7月至2013年1月北京大学人民医院脊柱科因脊髓型颈椎病接受颈椎后路手术的60例患者。根据固定方式不同,将所有患者分为颈椎后路开门Centerpiece固定组(A组)和颈椎后路开门丝线悬吊固定组(B组)。A组40例,男25例,女15例,平均年龄(59.7±11.9)岁,术前平均病程(53.6±61.5)个月,术后平均随访时间(28.5±3.1)个月。B组20例,男15例,女5例,平均年龄(58.3±9.6)岁,术前平均病程(50.4±14.9)个月,术后平均随访时间(28.3±1.9)个月。观察手术时间、术中出血量、术后引流量、术前及术后日本骨科协会(JOA)评分、颈部功能障碍指数(NDI)评分、视觉模拟评分(VAS)评分、术后轴性疼痛、C(5)神经根麻痹、术后“再关门”等相关并发症。影像学评估项目包括:颈椎曲度、活动度(ROM)、脊柱前后径、椎管扩大率、脊髓整体后移距离、椎管面积及开门角度手术前后情况。两组一般资料比较差异无统计学意义(>0.05)。A组平均手术时间为(117.7±23.4)分钟,平均术中出血量为(152.0±122.7)毫升,术后引流量为(268.7±222.1)毫升。B组平均手术时间为(141.7±23.9)分钟,平均术中出血量为(166.7±42.5)毫升,B组术后引流量为(255.3±47.0)毫升。两组术中出血量及术后引流量比较差异无统计学意义(均>0.05),两组手术时间比较差异有统计学意义(<0.05)。随访结束时,A组和B组JOA评分、NDI评分及VAS评分均显著改善(<0.05),两组间比较差异无统计学意义(>0.05)。两组术后均未发生C(5)神经根麻痹。A组有1例发生轴性疼痛,B组有7例,两组间差异有统计学意义(<0.05)。随访期间A组未发现“再关门”现象,B组有12例出现“再关门”现象,两组间差异有统计学意义(<0.05)。两组术前与术后颈椎曲度及ROM比较差异无统计学意义(>0.05)。但两组术后椎管直径及椎管面积比较差异有统计学意义(<0.05)。两组颈椎曲度及ROM比较差异无统计学意义(>0.05)。两组椎管直径、椎管面积及椎管直径扩大率比较差异无统计学意义(>0.05)。两组脊髓整体后移距离比较差异无统计学意义(>0.05)。两组开门角度比较差异有统计学意义(<0.05)。Centerpiece颈椎后路钛板在治疗多节段脊髓型颈椎病中可取得良好的临床疗效。