Xu Derong, Zhou Chuanli, Tao Hao, Zhu Kai, Wang Chao, Peng Chen, Zhang Hao, Song Mengxiong, Ma Xuexiao
Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao City, China.
Br J Neurosurg. 2024 Feb;38(1):88-93. doi: 10.1080/02688697.2021.1923647. Epub 2022 Feb 3.
To identify the clinical characteristics of fractured hinges after open-door cervical laminoplasty for cervical canal stenosis and explore the relationship between hinge fractures and axial symptoms.
This was a retrospective study of patients with cervical myelopathy who underwent open-door laminoplasty between November 2014 and November 2016 at the Affiliated Hospital of Qingdao University. Cervical CT scans were performed after surgery and the Takeuchi criteria were applied to evaluate the postoperative axial symptoms.
Of 223 opened laminae in 67 patients, 67 laminae (30.0%) in 30 patients (44.8%) showed fracture. The frequency of hinge fractures was higher at C6 (53.7%). Forty-nine fractured laminae (73.13%) were non-displaced and 18 were displaced. At 3 months, 33 fractured laminae (49.3%) showed bony union on CT, and union rates were 86.6% and 91.0% at 6 and 12 months, respectively, indicating that the union rate was lower for displaced fractures than for non-displaced fractures. Among the 67 patients, 14 had axial symptoms: three of 37 (8.1%) patients without hinge fractures and 11 of 30 (36.7%) patients with hinge fractures. One year later, the hinge fractures were healed in 24/30 patients. Among the six unhealed patients, five still suffered from axial symptoms. The frequency of axial symptoms was higher in the patients with three or more hinge fractures (66.7%) than in the patients with only one (16.7%) or two (46.7%) hinge fractures.
Patients with hinge fractures may have an increased risk for axial symptoms after open-door cervical laminoplasty. The frequency of axial symptoms decreases with fracture healing.
明确颈椎管狭窄症行单开门颈椎板成形术后铰链骨折的临床特征，并探讨铰链骨折与轴性症状之间的关系。
本研究为回顾性研究，纳入2014年11月至2016年11月在青岛大学附属医院接受单开门颈椎板成形术的脊髓型颈椎病患者。术后行颈椎CT扫描，并应用竹内标准评估术后轴性症状。
67例患者共223个开门椎板中，30例患者（44.8%）的67个椎板（30.0%）发生骨折。C6节段铰链骨折发生率更高（53.7%）。49个骨折椎板（73.13%）无移位，18个有移位。术后3个月，CT显示33个骨折椎板（49.3%）出现骨愈合，6个月和12个月时的愈合率分别为86.6%和91.0%，提示移位骨折的愈合率低于无移位骨折。67例患者中，14例有轴性症状：37例无铰链骨折患者中有3例（8.1%），30例有铰链骨折患者中有11例（36.7%）。1年后，30例患者中有24例铰链骨折愈合。6例未愈合患者中，5例仍有轴性症状。铰链骨折3处及以上的患者轴性症状发生率（66.7%）高于仅有1处（16.7%）或2处（46.7%）铰链骨折的患者。
单开门颈椎板成形术后铰链骨折患者发生轴性症状的风险可能增加。轴性症状的发生率随骨折愈合而降低。
