保留双侧半棘肌改良单开门椎管扩大钢板置入：减少轴性症状及 颈椎曲度丢失

保留双侧半棘肌改良单开门椎管扩大钢板置入：减少轴性症状及 颈椎曲度丢失 安忠诚，曹  瑞，盛伟斌，梁卫东，盛  军(新疆医科大学第一附属医院脊柱外科，新疆维吾尔自治区乌鲁木齐市  830000) 引用本文：安忠诚，曹瑞，盛伟斌，梁卫东，盛军. 保留双侧半棘肌改良单开门椎管扩大钢板置入：减少轴性症状及颈椎曲度丢失[J].中国组织工程研究，2016，20(13):1873-1879. DOI: 10.3969/j.issn.2095-4344.2016.13.007    ORCID: 0000-0002-8237-836X (安忠诚) 文章快速阅读： 保留双侧半棘肌改良单开门椎管扩大成形钢板置入修复多节段颈椎病的特点 安忠诚，1989年生，安徽省淮南市人，回族，新疆医科大学在读硕士，主要从事脊柱疾患的基础与临床研究。 通讯作者：盛伟斌，博士，主任医师，教授，博士生导师，新疆医科大学第一附属医院脊柱外科(骨科)，新疆维吾尔自治区乌鲁木齐市 830000 中图分类号:R318 文献标识码:A 文章编号:2095-4344 (2016)13-01873-07 稿件接受：2016-01-12 文题释义：双侧半棘肌：半棘肌位干棘肌的深面，按部位又分为头、颈、背半棘肌。传统颈椎后路单开门手术需从棘突两侧剥离椎旁肌肉，不仅创伤大而且会产生脊柱序列不齐、后凸畸形等问题。作者对其进行了研发改良，保留了双侧颈半棘肌，减少了对后方肌肉韧带复合体的损伤，可最大限度的保留颈椎曲度和颈椎活动度，减少后凸畸形的发生率。轴性症状：1999年川口善治将椎板成形后产生长期的颈项部及肩背部疼痛，伴有酸胀、僵硬、沉重感和肌肉痉挛为主的症状定义为轴性症状，轴性症状分布较广，自头顶达耳后、枕下、颈后两侧、肩后部及肩胛肩区，并且呈节段性分布，与脊神经后支支配区相吻合，相邻皮节区彼此交叉重叠，主要分布在C2-3和C6-7皮节支配区，严重的轴性症状经理疗、颈肌锻炼和药物治疗均很难取得满意疗效。 摘要背景：临床上使用颈椎单开门椎管扩大成形修复慢性压迫性颈脊髓病效果确切。为减少修复后并发症的发生，临床医生提出了不同的改良修复 方案 气瓶 现场处置方案 .pdf气瓶 现场处置方案 .doc见习基地管理方案.doc关于群访事件的化解方案建筑工地扬尘治理专项方案下载 ，虽具有一定效果，但对减少修复后并发症方面疗效欠佳。目的：评价保留双侧半棘肌的改良肌间隙修复入路在颈椎单开门椎管扩大成形钢板置入中的应用效果。方法：回顾性分析2013年10月至2014年3月行保留双侧半棘肌的改良肌间隙入路颈椎单开门椎管扩大成形治疗的30例多节段颈椎病患者的临床资料，内固定材料为Centerpiece钛板固定系统。统计对比治疗前及随访时患者的目测类比 评分 售楼处物业服务评分营养不良炎症评分法中国大学排行榜100强国家临床重点专科供应商现场质量稽核 、日本骨科协会JOA评分(17分)、颈椎功能障碍指数、颈椎总活动度及颈椎曲度，并评估治疗后轴性疼症状的严重程度。结果与结论：患者治疗后随访12-24个月。所有患者修复过程中无脊髓损伤、脑脊液漏、感染及C5神经根麻痹等并发症发生。仅1例患者修复术后出现轴性疼痛症状，但无需口服止疼药。日本骨科协会JOA评分改善率为(76.96±17.61)%；颈椎功能障碍指数由治疗前12.29±3.82降为末次随访的8.24± 2.86；末次随访时颈椎总活动度为(47.41±17.33)°，为治疗前的(93.0±4.2)%；颈椎曲度由治疗前(13.47±10.54)°变为末次随访时(12.88±8.56)°。提示保留双侧半棘肌的改良肌间隙入路应用于颈椎单开门椎管扩大成形钢板置入治疗中，可最大限度保留颈椎后方结构，有利于患者修复后早期功能锻炼，减少轴性症状发生率和颈椎曲度的丢失。 关键词：骨科植入物；脊柱植入物；多节段颈椎病；椎管扩大成形；钢板置入；轴性症状；颈椎活动度；颈椎曲度主题词：颈椎；椎体成形术；内固定器；组织工程Modified open-door laminoplasty with steel implantation and bilateral semispinalis reduces axial symptoms and the loss of cervical curvature An Zhong-cheng, Cao Rui, Sheng Wei-bin, Liang Wei-dong, Sheng Jun (Department of Spine Surgery, the Frist Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China) Abstract BACKGROUND: Cervical single-door laminoplasty for chronic compressive myelopathy has obtained exact effects. To reduce the occurrence of related complications, different doctors have proposed different improvement programs, and have achieved a certain effect, but the effect on postoperative complications is not very well. OBJECTIVE: To evaluate the effect of modified open-door laminoplasty with steel implantation and preservation of bilateral semispinalis. METHODS: We retrospectively analyzed the data of 30 cases of multilevel cervical spondyiotic myelopathy who underwent modified open-door laminoplasty from October 2013 to March 2014. Internal fixation material was Centerpiece titanium plate fixation system. Visual Analogue Scale score, Japanese Orthopaedic Association score (17-score method), neck disability index, range of motion of cervical vertebra, and cervical curvature were compared before treatment and during follow-up. Axial symptom severity was assessed after treatment. RESULTS AND CONCLUSION: The patients were followed up for 12-24 months. No complications appeared during repair, including postoperative spinal cord injury, cerebrospinal fluid leakage, infection or C5 nerve root palsy. Only one patient suffered from axial pain, but there was no need for oral medication. The improvement rate of Japanese Orthopaedic Association score was (76.96±17.61)%. Neck disability index decreased from 12.29±3.82 preoperatively to 8.24±2.86 in final follow-up. Range of motion of cervical vertebra (47.41±17.33)° in final follow-up, accounting for (93.0±4.2)% of preoperative data. Cervical curvature decreased from (13.47±10.54)° preoperatively to (12.88±8.56)° in final follow-up. These findings confirm that modified open-door laminoplasty with preservation of bilateral semispinalis can reserve cervical rear structure to maximum extent, is conducive to early functional exercise after rehabilitation, and reduces the incidence of axial symptoms and loss of cervical curvature.  Subject headings: Cervical Vertebrae; Vertebroplasty; Internal Fixators; Tissue Engineering Cite this article: An ZC, Cao R, Sheng WB, Liang WD, Sheng J. Modified open-door laminoplasty with steel implantation and bilateral semispinalis reduces axial symptoms and the loss of cervical curvature. Zhongguo Zuzhi Gongcheng Yanjiu. 2016;20(13):1873-1879. An Zhong-cheng, Studying for master’s degree, Department of Spine Surgery, the Frist Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China Corresponding author: Sheng Wei-bin, M.D., Chief physician, Professor, Doctoral supervisor, Department of Spine Surgery, the Frist Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China 0  引言  Introduction 脊髓型脊椎病发病率为12%-30%[1]，占颈椎病发生率的10%-15%[2]，是脊柱外科及其常见的疾病，由于其压迫脊髓可造成四肢瘫痪因而致残率较高，因此其在各类型颈椎病中危害最大，严重影响患者的生活及工作，且其发病隐匿，起病较为缓慢，病程较长，病程越长者往往预后较差。因此大多数学者认为脊髓型颈椎病一旦诊断明确，应当尽早手术治疗。不同修复方式往往直接影响疗效，目前修复多节段脊髓型颈椎病后路减压手术主要包括后路椎板切除内固定、单开门椎管扩大成形、双开门椎管扩大成形和可复式椎管扩大成形等[3-4]。 继续阅读