【摘要】 目的探讨自制锚钉在颈后路单开门椎管扩大椎板成形术(ELAP)中的应用效果。方法在32例行ELAP的患者术中使用自制侧块锚钉"门轴"侧固定。采用JOA评分及影像学检查进行临床疗效评价。结果32例锚钉置入过程均顺利,无血管、神经损伤。手术时间75～160(96±12.6)min,术中出血量180～800(280±48.6)ml。术后脑脊液漏1例,无脊髓损伤、硬膜外血肿等并发症发生。31例患者获得随访,时间12～28个月。疗效评价:JOA评分11～16(14.2±3.2)分,与术前比较差异有统计学意义(P<0.05),改善率为(56.1±8.5)%,优良率为92%。C5神经根麻痹6例、轴性症状11例,均对症处理后症状好转。影像学显示:患者门轴侧均得到骨性愈合,同节段椎管前后径增加22%±9.0%,锚钉无松动,无颈椎不稳、椎板塌陷及再关门现象。结论 ELAP中使用自制锚钉操作简单、安全性高、价格低廉,并能有效维持椎板于开门状态,短期疗效满意。更多还原

【Abstract】 Objective To evaluate the clinical application value of the self-designed lateral mass anchor in expansive open-door laminoplasty(ELAP).Methods 32 cases were subjected to ELAP with the self-designed lateral mass anchor fixation.The JOA scores and imaging data were used to evaluate clinical results of these cases.Results During the operation,the nails were smoothly placed.There was no neurological and vertebral artery injury after the self-designed cervical lateral mass anchor fixation.The mean operative time,mean volume of bleeding was 75~160(96±12.6)min,180~800(280±48.6)ml respectively.Cerebrospinal fluid leakage occurred in one case,and there was no complication such as spinal cord injury,hematoma outside of the scleromeninx and so forth.The follow-up was 12~28 months,the postoperative JOA scores were 11~16(14.2±3.2)points,which was statistically significant differents compared with the results before operation(P<0.05).The average improvement rate was(56.1±8.5)% and the rate of excellent and good results was 92%.There were 6 patients having C5 palsy and 11 patients having neck and shoulder pain after operation,power of paralyzed muscles of 4 patients recovered to normal,2 patients recovered to 3~4 grade,and the pain disappeared with conservative treatments,including functional exercises,drug administration and high-pressure oxygen therapy.The imaging data evaluation showed the anterior-posterior diameter of the canal were increased by 22%±9.0% at the same section,and there was no screw loosening,cervical instability and reclose of the opened laminae.Conclusions The ELAP using the self-designed anchor has the advantage of easy manipulation,low price and high safety.It can avoid "door re-closure" and short term result is satisfactory.更多还原