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目的探讨应用Centerpiece微型钢板行颈后路单开门椎管扩大成形术的早期临床效果,并借助数字化CT的方法探究颈椎单开门手术中C7椎最佳的开槽数据,为精确化手术提供参考。方法回顾性分析2013年2月至11月在四川大学华西医院进行手术治疗的颈椎单开门椎板成形Centerpiece内固定术患者。比较患者术前和术后各随访时点的神经功能评估结果(JOA评分)、颈椎曲度指数、Pavlov值、椎管横截面积及不同位置、角度、深度C7椎板开槽数据的差异。结果共纳入58例患者,其术后JOA评分明显高于术前,且差异有统计学意义(9.4±2.9vs.14.7±2.6,t=11.417,P=0.000)。末次随访时椎管矢状径(21.3±2.1 mm vs.9.7±2.1 mm,t=27.737,P=0.000)、Pavlov值(0.92±0.13 vs.0.44±0.12,t=30.621,P=0.000)及椎管横截面积(276±37 mm2 vs.129±25 mm2,t=32.104,P=0.000)明显大于术前,且差异均有统计学意义,而末次随访时颈椎曲度指数与术前相比差异有统计学意义(11.2±11.5 vs.9.3±11.7,t=–1.713,P=0.000)。C7椎板开门侧理想开槽位置和角度与手术实际开槽位置和角度比较,差异均有统计学意义(P均<0.05);C7椎板铰链侧理想开槽位置和角度与手术实际开槽位置和角度比较,差异无统计学意义(P均>0.05),但理想开槽深度与手术实际开槽深度比较,差异有统计学意义(P<0.05)。结论 Centerpiece微型钢板应用于颈后路单开门椎板成形术的椎板固定无螺钉松动和钢板断裂,能有效维持椎板的开门状态,防止再关门的发生;患者术后神经功能恢复良好,临床效果佳。
Objective To explore the early clinical effect of using the Centerpiece mini-plate in the posterior cervical spine open-door laminoplasty and to explore the best groove data of the C7 vertebra in single-door cervical spine surgery by means of digital CT, so as to provide a reference for accurate surgery. Methods A retrospective analysis of patients undergoing open-center cervical vertebroplasty with vertebral plate fixation from February 2013 to November in West China Hospital of Sichuan University was performed. The results of neurological function assessment (JOA score), cervical curvature index, Pavlov value, spinal canal cross-sectional area, and the differences in the position, angle, and depth of C7 lamina were compared between preoperative and postoperative follow-up. Results A total of 58 patients were enrolled. The postoperative JOA score was significantly higher than that before operation (9.4 ± 2.9 vs.14.7 ± 2.6, t = 11.417, P = 0.000). The sagittal diameter (21.3 ± 2.1 mm vs.9.7 ± 2.1 mm, t = 27.737, P = 0.000), Pavlov value (0.92 ± 0.13 vs.0.44 ± 0.12, t = 30.621, P = 0.000) The spinal canal cross-sectional area (276 ± 37 mm2 vs.129 ± 25 mm2, t = 32.104, P = 0.000) was significantly higher than that before operation, and the differences were statistically significant. However, the cervical curvature index at the last follow- The difference was statistically significant (11.2 ± 11.5 vs.9.3 ± 11.7, t = -1.713, P = 0.000). The position and angle of the ideal notch on the open side of the C7 lamina were significantly different from the actual position and angle of the surgical incision (all P <0.05) (P> 0.05). However, there was a significant difference between the ideal depth of incision and the actual incision depth (P <0.05). Conclusion The application of Centerpiece mini-plate in cervical posterior open-door laminoplasty without screw loosening and plate rupture can effectively maintain the open state of the lamina and prevent the reopening of the door. The postoperative neurological function recovered well and the clinical Good effect.