Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Rd., Wuhou District, Chengdu, 610041, Sichuan, PR China.
Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Rd., Wuhou District, Chengdu, 610041, Sichuan, PR China.
Spine J. 2020 Nov;20(11):1761-1769. doi: 10.1016/j.spinee.2020.06.018. Epub 2020 Jun 29.
Titanium mini-plate has been used in unilateral open-door laminoplasty to maintain the open angle of laminae. Previously, both all-level fixation (C3-C7) and alternative-level (C3, C5, C7) unilateral open-door laminoplasty have been proven to have satisfactory clinical outcomes. However, whether they could achieve similar long-term clinical and radiographic efficacy is still questionable.
To compare the long-term clinical and radiological outcomes between alternative-level and all-level fixation unilateral open-door laminoplasty with a mini-plate fixation system.
STUDY DESIGN/SETTING: Retrospective comparative study.
Ninety-one patients who underwent unilateral open-door laminoplasty.
Clinical results including Japanese Orthopedic Association score, Visual Analogue Score, Neck Dysfunction Index score. Radiographic results including cervical curvature index, cervical range of motion, and the spinal canal expansive parameters, including anteroposterior diameter, Pavlov's ratio, and open angle.
Between April 2007 and June 2011, 91 patients with minimum 7-year postoperative follow-up were included. Thirty-eight underwent alternative-level fixation (group A) and 53 underwent all-level fixation (group B). Demographic data, including age, gender, operative time, blood loss, and cost, were collected and compared between the two groups. Clinical and radiographic data were obtained preoperatively, at 3 and 6 months and 1 and 3 years postoperatively, as well as at final follow-up. The difference between the two groups and between different time points within one group was compared.
Both groups obtained satisfactory clinical outcomes till the final follow-up. No statistic difference was found in Japanese Orthopedic Association, Visual Analogue Score, and Neck Dysfunction Index between the two groups throughout the whole follow-up. Both groups maintained APD and Pavlov's ratio well till follow-up. However, statistic difference was found in the open angle between two groups at final follow-up (34.17±2.75° vs. 36.19±1.80°, p<.05). When we subdivided the cervical segments in group A, we found the mini-plate segments showed maintenance in open angle but a 4.52° decrease in suture segments. The mean cost in group B (17,669.82±1,157.65 $) was significantly higher than in group A (11,452.19±871.07 $; p<.05).
Despite a difference in the maintenance of open angle, both fixation methods achieved satisfactory clinical outcomes. We believe alternative-level fixation is also a safe, effective, and economical fixation method.
钛板迷你板已用于单侧开门椎管成形术以维持椎板的张开角度。以前，全节段固定（C3-C7）和选择性节段固定（C3、C5、C7）的单侧开门椎管成形术均已被证明具有令人满意的临床效果。但是，它们是否可以达到相似的长期临床和影像学效果仍存在疑问。
比较使用迷你板固定系统的选择性节段与全节段固定的单侧开门椎管成形术的长期临床和影像学结果。
研究设计/设置：回顾性比较研究。
91 例接受单侧开门椎管成形术的患者。
临床结果包括日本骨科协会评分、视觉模拟评分、颈部功能障碍指数评分。影像学结果包括颈椎曲度指数、颈椎活动度以及椎管扩张参数，包括前后径、Pavlov 比值和张开角。
2007 年 4 月至 2011 年 6 月，91 例患者术后随访至少 7 年。其中 38 例采用选择性节段固定（A 组），53 例采用全节段固定（B 组）。收集并比较两组患者的人口统计学数据，包括年龄、性别、手术时间、出血量和费用。术前、术后 3 个月、6 个月、1 年和 3 年以及最终随访时均获得临床和影像学资料。比较两组之间以及同一组内不同时间点之间的差异。
两组患者在整个随访期间均获得了满意的临床效果。两组患者的日本骨科协会评分、视觉模拟评分和颈部功能障碍指数在整个随访过程中均无统计学差异。两组患者的 APD 和 Pavlov 比值在随访期间均保持良好。然而，两组患者在最终随访时的开口角存在统计学差异（34.17±2.75° vs. 36.19±1.80°，p<.05）。当我们对 A 组的颈椎节段进行细分时，我们发现迷你板节段在维持开口角方面表现良好，但在缝线节段却减少了 4.52°。B 组的平均费用（17669.82±1157.65 美元）明显高于 A 组（11452.19±871.07 美元；p<.05）。
尽管在开口角的维持方面存在差异，但两种固定方法均取得了满意的临床效果。我们认为选择性节段固定也是一种安全、有效且经济的固定方法。
