超声骨刀棘突切除颈椎单开门椎板成形术

Unilateral open-door laminoplasty combined with total spinous process resection by ultrasound osteotome

摘要:

［目的］ 介绍超声骨刀棘突切除改良颈椎单开门椎板成形术的手术技术和初步临床结果。［方法］ 2020 年 1 月— 2021 年 12 月对 30 例脊髓型颈椎病患者行该术式治疗。切皮前切口周围注射稀释的肾上腺素盐水。手术取颈后正中切口，剥离 C3~C6椎板上的颈旁肌，显露棘突和椎板。使用超声骨刀在压迫较轻侧椎板和侧块关节交界处开槽作门；超声骨刀的三角形刀头在对侧做门轴；将椎板逐个掀起，扩大椎管。选取大小合适的 Z 形钛板置于相应的开门节段中并用螺钉固定，使用超声骨刀创新性地沿 C3~C6棘突根部切除全部的棘突。［结果］患者均顺利完成手术，无严重并发症。VAS 评分由术前平均（3.6±0.9） 分改善至末次随访平均（1.2±0.6）分；JOA 评分由术前平均（8.5±1.2）分改善至末次随访平均（15.0±0.9）分，差异均有统计学意义（P<0.05）。所有患者在随访期间均未出现螺钉及钛板松动、脱落现象，也未出现“再关门”现象。［结论］切除 C3~C6的全部棘突可明显减少棘突对颈部肌肉的应力遮挡，且双侧基本对称的结构更有利于术后肌肉组织的附着。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of unilateral open-door laminoplasty com- bined with total spinous process resection by ultrasound osteotome for cervical spondylotic myelopathy. [Methods] From January 2020 to December 2021, 30 patients received aforesaid surgical treatment for cervical spondylotic myelopathy. As diluted epinephrine saline solu- tion was injected around the incision, a posterior midline incision was made to expose the spinous process and lamina by dissecting bilateral paraspinous muscles from C₃ to C₆. An ultrasonic osteotome was used to make grooves with a thin intact inner plate along the junction of the lamina and lateral mass on the axial side, whereas full layer resection on the decompression side (the symptomatic side) . Lifting the lamina one by one to widen and decompress the spinal canal, and then the corresponding open-door segments were fixed with Z-shaped titanium plates in appropriate size to maintain the lamina opening. Subsequently, C3~C6 spinous process were totally removed from the base by ultra- sonic osteotome to facilitate reattachment of paraspinous muscles without dead space. [Results] All the patients had operation performed successfully without serious complications. The VAS score was improved from (3.6±0.9) before operation to (1.2±0.6) at the last follow-up, while JOA score was improved from (8.5±1.2) preoperatively to (15.0±0.9) at the latest follow-up, which all were statistically significant (P＜ 0.05) . During the follow-up period, none of implant loosening and fracture, nor “re-closing” phenomenon were noted in anyone of the 30 patients. [Conclusion] Total resection of spinous processes of C3~C6 might reduce the stress shielding on the neck muscles, and this bilater- al basically symmetrical construct is more conducive to the reattachment of muscles.