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开门式颈椎椎板成形术中铰链骨折后的临床及影像学结果

Clinical and radiographic outcomes following hinge fracture during open-door cervical laminoplasty.

作者信息

Lee Dong-Ho, Kim Hyoungmin, Lee Choon Sung, Hwang Chang-Ju, Cho Jae-Hwan, Cho Samuel K

机构信息

Department of Orthopedic Surgery, Asan Medical Center & Ulsan University College of Medicine, Seoul, South Korea.

Department of Orthopedic Surgery, Seoul National University Hospital & Seoul National University College of Medicine, Seoul, South Korea.

出版信息

J Clin Neurosci. 2017 Sep;43:72-76. doi: 10.1016/j.jocn.2017.04.037. Epub 2017 May 8.

Abstract

To investigate the clinical and radiographic fate of fractured hinges in open-door cervical laminoplasty, 135 segments of 36 patients who had undergone follow-up for more than two years after open-door cervical laminoplasty due to compressive cervical myelopathy were reviewed clinically and radiographically. Hinge fractures were identified by the intraoperative finding of obvious instability or click sounds (an obvious fracture), or by immediate postoperative computed tomography (CT) images showing a discontinuity of both the inner and outer cortex or a displacement of more than 1mm at the lamina hinge site (an occult fracture). At two years post-surgery, union and displacement of the fractured hinges were evaluated with CT and the clinical outcome was assessed by the Japanese Orthopedic Association (JOA) and Neck Disability Index (NDI) scores. Immediate postoperative CT scans revealed 28 hinge fractures in 16 patients. Only three fractures were identified during surgery, with most being identified on postoperative CT. Nineteen laminae showed non-displaced cortical discontinuity, five were anteriorly displaced by more than 1mm, and four were displaced posteriorly. Twenty-five laminae (89.3%) had achieved union according to the two-year postoperative CT scan. No de novo neurologic symptoms were found to be associated with hinge fracture. The two-year postoperative JOA and NDI scores did not differ significantly between patients with or without a hinge fracture. Most fractures at the hinge site occurred without intraoperative recognition, and usually re-unified without significant displacement or adverse clinical effects. When hinge fractures occur, careful observation without additional intervention is recommended.

摘要

为了研究开门式颈椎椎板成形术中骨折铰链的临床和影像学转归,对36例因颈椎脊髓病行开门式颈椎椎板成形术且随访超过两年的患者的135个节段进行了临床和影像学回顾。铰链骨折通过术中发现明显不稳定或弹响(明显骨折)来确定,或通过术后即刻计算机断层扫描(CT)图像显示椎板铰链部位内外皮质均连续中断或移位超过1mm(隐匿性骨折)来确定。术后两年,用CT评估骨折铰链的愈合和移位情况,并通过日本骨科协会(JOA)评分和颈部功能障碍指数(NDI)评估临床疗效。术后即刻CT扫描显示16例患者有28处铰链骨折。术中仅发现3处骨折,大多数骨折是在术后CT上发现的。19个椎板显示皮质连续中断但无移位,5个向前移位超过1mm,4个向后移位。根据术后两年的CT扫描,25个椎板(89.3%)已愈合。未发现新的神经症状与铰链骨折相关。有或无铰链骨折患者的术后两年JOA评分和NDI评分差异无统计学意义。大多数铰链部位的骨折在术中未被发现,通常会重新愈合,无明显移位或不良临床影响。当发生铰链骨折时,建议仔细观察,无需额外干预。

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