摘要目的 探讨颈椎后路钛板(Centerpiece)内固定和丝线悬吊内固定治疗脊髓型颈椎病的临床疗效.方法 对2011年7月至2013年1月因脊髓型颈椎病在北京大学人民医院行颈椎后路手术的60例患者进行回顾性研究.根据固定方式的不同,分为颈后路单开门Centerpiece内固定组(A组)和颈后路单开门丝线悬吊内固定组(B组).A组40例患者,其中男性25例、女性15例,平均年龄(59.7±11.9)岁,术前平均病程(53.6±61.5)个月,术后平均随访时间(28.5±3.1)个月;B组20例患者,其中男性15例、女性5例,平均年龄(58.3±9.6)岁,术前平均病程(50.4±14.9)个月,术后平均随访时间(28.3±1.9)个月.记录两组患者手术时间、术中出血量、术后引流量,手术前后日本骨科协会(JOA)评估治疗17分法评分(JOA评分)、颈椎功能障碍指数(NDI)评分及疼痛视觉模拟量表(VAS)评分,观察术后是否出现轴性疼痛、C5神经根麻痹,术后是否发生“再关门”;影像学评估项目包括:手术前后颈椎曲度、颈椎活动度、椎管前后径、椎管扩大率、脊髓整体向后移位距离、椎管面积以及开门角度.两组样本的计量资料均符合正态分布,同组术前、术后评分采用配对样本t检验,两组间同项指标采用两独立样本t检验,计数资料采用x2检验.结果 两组患者一般资料的差异无统计学意义(P＞0.05).A组患者平均手术时间(117.7±23.4) min,平均手术出血量(152.0±122.7) ml,术后引流量(268.7±222.1)ml;B组患者平均手术时间(141.7±23.9) min,平均手术出血量(166.7±42.5) ml,术后引流量(255.3±47.0) ml;两组患者手术出血量和术后引流量的差异无统计学意义(P值均＞0.05),两组患者手术时间的差异有统计学意义(P＜0.05);末次随访时,两组患者JOA评分、NDI评分、VAS评分较术前均有明显改善,差异有统计学意义(P值均＜0.05),两组改善率的差异无统计学意义(P＞0.05).两组患者术后均未出现C5神经根麻痹.A组1例、B组7例患者术后出现轴性疼痛,两组差异有统计学意义(P＜0.05).A组患者随访时未发现“再关门”现象,B组患者随访时有12例患者出现“再关门”现象,两组差异有统计学意义(P＜0.05).术后随访时与术前比较,两组患者颈椎曲度、颈椎活动度的差异均无统计学意义(P＞0.05),椎管前后径、椎管面积的差异均有统计学意义(P值均＜0.05);两组患者之间颈椎曲度、颈椎活动度的差异亦无统计学意义(P＞0.05);两组患者椎管前后径、椎管面积和椎管前后径扩大率的差异均无统计学意义(P值均＞0.05);术后随访时,两组患者脊髓后移距离的差异无统计学意义(P＞0.05),开门角度的差异有统计学意义(P＜0.05).结论 Centerpiece内固定治疗多节段脊髓型颈椎病的临床疗效优于丝线悬吊内固定.

abstractsObjective To evaluate the clinical effect and imaging evaluation of cervical spine myelopathy treated with Centerpiece.Methods A retrospective study of 60 patients underwent posterior cervical spine surgery because of cervical myelopathy in Spinal Department of Peking University People's Hospital from July 2011 to January 2013.According to the different fixation methods,all patients were divided into cervical posterior open-door Centerpiece fixation group (group A) and cervical posterior opendoor silk suspension fixation group (group B).There were 40 patients in group A,including 25 males and 15 females,mean age (59.7 ± 11.9) years old,average course of disease before surgery (53.6±61.5) months,average follow-up time (28.5±3.1) months after operation.There were 20 patients in group B,including 15 males and 5 females,mean age (58.3±9.6) years old,average course of disease before surgery (50.4± 14.9) months,average follow-up time (28.3 ± 1.9) months after operation.The operation time,intraoperative blood loss,postoperative drainage,preoperative and postoperative Japanese Orthopaedic Association(JOA) score,the neck disability index (NDI) score,visual analog scale (VAS) score,postoperative axial pain,Cs nerve root palsy,postoperative "re-closing" and other related complications were observed.Imaging assessment projects include:before and after surgery of cervical curvature,range of motion (ROM),spinal anteroposterior diameter,spinal canal expansion rate,the whole spinal cord backward shift distance and area of the spinal canal and the opening angle.Results There was no significant difference in general data between the two groups (P＞0.05).Group A the average operation time was(117.7±23.4) min,the average amount of operative bleeding was (152.0±122.7) ml,and the postoperative drainage volume was (268.7± 222.1) ml.The average operation time of group B was (141.7 ± 23.9) min,the average amount of operative bleeding was (166.7±42.5) ml,and the postoperative drainage volume of group B was (255.3±47.0) ml.There was no significant difference between the two groups in the amount of operative bleeding and postoperative drainage volume (both P＞0.05),the operation time between the two groups was statistically significant (P＜0.05).At the end of the follow-up,the JOA score,NDI score,and VAS score were significantly improved (P＜0.05) in both group A and group B and there was no significant difference between the two groups (P＞ 0.05).C5 nerve root paralysis was not occurred in both two groups after operation.There were 1 case of axial pain in the group A and 7 cases in the group B and there were significant differences between the two groups (P＜0.05).The group A was not found "re-closing" during the follow-up and 12 patients of group B found to be "re-closing" phenomenon,there were statistically different between the two groups (P＜0.05).Comparison of preoperative and postoperative,there were no significant differences in cervical curvature and ROM in both groups (P＞0.05).Butthe spinal canal diameter and the vertebral canal area were statistically different after surgery (P＜0.05).There was no statistical difference between the two groups of cervical curvature and ROM (P ＞ 0.05).There was no statistical difference between the two groups of spinal canal diameter,spinal canal area and spinal canal diameter enlargement rste(P＞0.05).There was no statistical difference between the two groups of the whole spinal cord backward shift distance(P＞0.05).There were significant differences between the two groups at the angle of the open door (P＜0.05).Conclusion Centerpiece cervical posterior titanium plate can achieve good clinical efficacy in the treatment of multi segmental spinal cervical spondylosis.