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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:

期数:

2024年03期

页码:

132-138

栏目:

脊柱专题

出版日期:

2024-06-05

文章信息/Info

Title:

Clinical study on the application of posterior hybrid fixation in cervical trauma combined with multisegmental spinal stenosis

作者:

王宏; 马骏雄; 项良碧

110016 沈阳，中国人民解放军北部战区总医院骨科

Author(s):

Wang hong;  Ma Junxiong;  Xiang Liangbi

Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang 110016, China

关键词:

颈椎外伤;  椎管狭窄;  椎管扩大成形;  短节段;  固定

Keywords:

Cervical trauma;  Spinal stenosis;  Spinal canal enlargement and plasty;  Short segments;  Fixation

DOI:

DOI：10.3877/cma.j.issn.2096-0263.2024.03.002

文献标志码:

A

摘要:

目的 颈椎后路椎板切除+融合固定是治疗颈椎外伤合并多节段颈椎管狭窄的常用术式，具有减压充分、并即刻恢复颈椎稳定性等优点。但却存在活动度丧失、脊髓后方缺乏保护、以及脊髓过度漂移致C5神经根麻痹等缺点。为此，本文通过临床对比研究，探讨后路hybrid固定方式（单开门椎管扩大成形、迷你钛板联合短节段钉棒混合固定）在颈椎外伤合并多节段椎管狭窄中应用的临床价值。方法 2017年1月至2018年12月在北部战区总医院骨科采取后路hybrid固定方式或传统椎板切除减压+融合固定治疗颈椎外伤合并多节段颈椎管狭窄病例共有72例，其中男39例，女33例，平均年龄58.2岁（35～73岁）；按照手术方式分为混合术式组（n=37）和传统术式组（n=35）；混合术式组是在责任节段行颈椎单开门椎管扩大成形术，失稳间隙同时行侧块钉棒固定、植骨融合；常规术式组是在责任节段行椎板切除减压、长节段钉棒固定融合。结果 平均随访2.2年（1～3.5年），末次随访时两组轴性颈肩痛发生率相似，JOA评分均较术前明显改善（P＜0.05），且组间无明显差异。但混合术式组术后的C5神经根麻痹发生率明显低于常规术式组（P＜0.05）；X线显示两组颈椎序列满意，融合节段均完成融合，无内固定松动、后凸畸形、失稳及“再关门”等现象发生。但混合术式组的颈椎活动度明显优于常规术式组（P＜0.05）。结论 对于颈椎外伤合并多节段椎管狭窄，混合术式组和传统术式组均能显著改善神经功能，但前者在保留颈椎活动范围，降低C5神经根麻痹等方面要明显优于后者。因此，椎管扩大成形、迷你钛板联合短节段钉棒混合固定是治疗颈椎外伤合并多节段椎管狭窄的一种有效方法。

Abstract:

Objective Posterior cervical laminectomy + fusion fixation is a commonly used procedure for the treatment of cervical spine trauma combined with multisegmental cervical stenosis, which has the advantages of adequate decompression and immediate restoration of cervical stability. However, it has the disadvantages of loss of mobility, lack of protection of the posterior spinal cord, and excessive spinal cord drift leading to C5 nerve root paralysis. In this paper, we investigated the clinical value of posterior hybrid fixation (Single-open-door enlarged spinal canal plasty, mini titanium plate combined with short segmental nail-rod hybrid fixation) in cervical trauma combined with multisegmental spinal stenosis through a comparative clinical study. Methods A total of 72 cases of cervical trauma combined with multisegmental cervical spinal stenosis were treated with posterior hybrid fixation approach or traditional laminectomy decompression + fusion fixation from January 2017 to December 2018 at Department of Orthopedics, General Hospital of Northern Theater Command. There were a total of 72 cases, including 39 males and 33 females, with a mean age of 58.2 years (35-73 years old); they were divided into a hybrid group (n=37) and a conventional group (n=35) according to the surgical approach; in the hybrid group, a single-door cervical spinal canal enlargement was performed at the responsible segment, and lateral block nail-rod fixation and fusion with implants were performed at the same time in the unstable gap; and in the conventional group, a laminectomy decompression was performed at the responsible segment, and the long segment was fixed and fused with a nail-rod fixation. In the conventional group, laminectomy and decompression were performed at the responsible segment, and long segment fusion was performed. Results With a mean follow-up of 2.2 years (1-3.5 years), the incidence of axial neck and shoulder pain was similar in both groups at the last follow-up, and the JOA scores were significantly improved compared with the preoperative period (P<0.05), and there was no significant difference between the groups. However, the incidence of C5 nerve root palsy in the hybrid group was significantly lower than that in the conventional group (P<0.05). X-rays showed that the cervical spine sequences of the two groups were satisfactory, and the fused segments were all fused, with no loosening of the internal fixation, kyphosis, destabilisation, or "re-closing" of the door. However, the cervical mobility of the hybrid group was significantly better than that of the conventional group (P<0.05). Conclusions For cervical trauma combined with multisegmental spinal stenosis, both the hybrid and traditional surgical groups significantly improved neurological function, but the former was significantly better than the latter in preserving the range of motion of the cervical spine and reducing C5 nerve root palsy. Therefore, the hybrid fixation of spinal canal enlargement and mini-titanium plate combined with short-segment nail and rod is an effective method for the treatment of multisegmental spinal stenosis combined with cervical spine trauma.

备注/Memo

备注/Memo:

基金项目：辽宁省自然基金指导计划（2019-ZD-1028）

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更新日期/Last Update: 2024-09-03