Department of Spine Surgery, Tianjin Hospital, Tianjin, China.
Department of Orthopaedics, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China.
J Neurol Surg A Cent Eur Neurosurg. 2024 Sep;85(5):513-519. doi: 10.1055/a-1995-1598. Epub 2022 Dec 8.
Open-door laminoplasty is a classical decompression method used to treat cervical spondylotic myelopathy. However, hinge fracture displacement (HFD) is a common occurrence during this procedure. The current study aimed to investigate the safety and efficacy of a combined imbrication axle reconstruction and Z-type titanium plate fixation method for HFD during open-door laminoplasty.
In total, 617 patients with cervical spondylotic myelopathy who underwent C3-C7 open-door laminoplasty from March 2015 to October 2018 were included in this retrospective study. Overall, 73 patients developed HFD during surgery. Of these, 43 underwent combined imbrication axle reconstruction and Z-type titanium plate fixation (IRZF group) and 30 underwent traditional titanium plate fixation (TF group). Data such as the operative time, intraoperative blood loss volume, and distribution of fractured hinges were recorded. Both groups were compared in terms of improvement in neurologic function, cervical curvature index, hinge fusion rate, incidence of C5 palsy, severity of axial symptoms, and development of complications.
The operative time and intraoperative blood loss were slightly higher in the IRZF group than in the TF group; however, the differences were not significant ( > 0.05). Furthermore, there was no significant difference between the groups in terms of the number of fractured segments and the distribution of fractured hinges ( > 0.05). The cervical curvature index did not decline in the two groups ( > 0.05). The IRZF group had a higher hinge fusion rate than the TF group at 3 (79.6 vs. 57.1%) and 12 (93.9 vs. 74.3%) months postoperatively ( < 0.05). There was no significant difference in the incidence of C5 palsy between the two groups (9.3 vs. 6.7%; > 0.05). However, the TF group had more severe axial symptoms than the IRZF group ( < 0.05). The neurologic function of the two groups increased postoperatively as per the Japanese Orthopaedic Association scoring system ( < 0.05). Nevertheless, there was no significant difference in terms of neurologic function at any observational time point ( > 0.05). One patient in the TF group with hinge nonunion underwent laminectomy due to lamina displacement into the spinal canal and nerve root compression.
In patients with HFD, IRZF facilitates a more intimate contact between the lamina and the lateral mass and, therefore, achieves fractured hinge fusion without additional surgical trauma. This technical improvement can significantly promote neurologic recovery, decrease the severity of axial symptoms, and prevent the development of spinal cord or nerve root recompression.
开门减压术是一种治疗脊髓型颈椎病的经典减压方法。然而，术中铰链骨折移位（HFD）是一种常见的并发症。本研究旨在探讨联合叠瓦式轴重建和 Z 型钛板固定治疗开门减压术中 HFD 的安全性和有效性。
回顾性分析 2015 年 3 月至 2018 年 10 月期间接受 C3-C7 开门减压术的 617 例脊髓型颈椎病患者的临床资料。其中 73 例术中发生 HFD，43 例行联合叠瓦式轴重建和 Z 型钛板固定（IRZF 组），30 例行传统钛板固定（TF 组）。记录手术时间、术中失血量和骨折铰链的分布情况。比较两组患者神经功能改善情况、颈椎曲度指数、铰链融合率、C5 神经麻痹发生率、轴性症状严重程度和并发症发生情况。
IRZF 组的手术时间和术中出血量略高于 TF 组，但差异无统计学意义（>0.05）。两组骨折节段数和骨折铰链分布无显著差异（>0.05）。两组颈椎曲度指数均无下降（>0.05）。术后 3 个月（79.6%比 57.1%）和 12 个月（93.9%比 74.3%）时，IRZF 组铰链融合率高于 TF 组（<0.05）。两组 C5 神经麻痹发生率无显著差异（9.3%比 6.7%；>0.05）。但 TF 组轴性症状严重程度较 IRZF 组严重（<0.05）。两组术后日本骨科协会评分均较术前改善（<0.05）。但各观察时间点神经功能比较差异均无统计学意义（>0.05）。TF 组 1 例铰链不愈合患者因椎板移位至椎管并神经根受压而行椎板切除术。
在 HFD 患者中，IRZF 可促进椎板与侧块更紧密接触，从而在不增加手术创伤的情况下实现骨折铰链融合。该技术改进可显著促进神经功能恢复，减轻轴性症状严重程度，并防止脊髓或神经根再次受压。
