Arch钛板与侧块螺钉固定治疗颈椎后纵韧带骨化症疗效比较

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Abstract Objective To compare the efficacy of Arch titanium plate fixation with lateral mass screws and titanium bars in the treatment of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.Methods From March 2012 to March 2016，33 patients suffering from posterior unilateral open-door cervical expansive laminoplasty due to ossification of the posterior longitudinal ligament of the orthopedic department of Xuzhou Medical University Hospital.The patients including 18 patients with lateral mass screw fixation and 15 patients with Arch plate fixation were followed up in the study.According to different surgical methods，the patients were divided into 2 group.The lateral mass screw group had 18 patients，and arch plate group had 15 patients.The sagittal diameter and opening angle of the C₄ segment were compared between the two groups before and after operation，and 6 months after operation.The open angle and open angle loss were measured 3 days after operation and 6 months after operation.The SF-36 quality of life was evaluated before and after the operation，and the activity of the cervical spine was evaluated before and after the follow-up.The postoperative neurological improvement was evaluated by JOA score and improvement rate.The cervical vertebrae X-ray，CT，and MRI were reviewed after operation.The cervical sagittal diameter of C₄ segment was measured at 6 months postoperatively.The expansion rate of the spinal canal and the angle of the door opening were evaluated.The condition of bone shaft healing was evaluated.All intraoperative and postoperative complications.Results The follow-up time was 6 to 24 months.Operation time of lateral mass screw group was (143.06±22.44) min，intraoperative blood loss was (256.95±32.23) mL.In arch plate group，operation time was (130.67±21.03) min，and intraoperative blood loss was (238.67±27.02) mL.There was no significant difference between the two groups in the operation time and intraoperative blood loss (P＞0.05).The JOA score of the lateral mass screw group were (8.39±2.38) beofre operaton and (12.00±2.20) 6 months later.The improvement rate of JOA score was (44.16±14.68)％.The JOA score of Arch plate group was (8.53±2.70) before operaton and (14.07±2.31) 6 months later.The improvement rate of JOA score was (68.56±15.73)％.There was significant difference in the improvement rate of JOA score between the two groups (P＜0.01).The sagittal diameter of C₄ segmental spinal canal in the lateral mass screw group was (6.20±1.26)mm preoperatively and (10.31±2.15)mm 6 months after operation.The sagittal diameter of C₄ segmental arch of Arch plate group was (6.39±1.39)mm preoperatively and (12.43±3.19)mm after 6 months.There was no significant difference in the sagittal diameter of C₄ segments between the two groups before operation (P＞0.05).There were significant differences in the sagittal diameter of C₄segments between the two groups 6 months after operation (P＜0.05).The angle of vertebral canal opening the lateral mass screw group was (25.57±3.95)° at 6 months after operation，and (29.67±4.16)° for Arch plate group at 6 months after operation.There were significant differences between the two groups in the angle of door opening (P＜0.01).Patients with open door angle loss were compared，and the difference was statistically significant (P`＜0.01).Two groups of patients were followed up for SF-36 quality of life evaluation，the difference was statistically significant (P＜0.01).There was significant difference between the two groups in the final follow-up cervical movement evaluation (P＜0.01).In the lateral mass screw group，there was 1 case of re-closing after operation.5 cases of axial symptoms occurred and relieved after symptomatic treatment.Arch plate group had no re-closing and axial symptoms.Two groups of patients had no internal fixation brending or breakage.The MRI examination showed significant relief of spinal cord compression at 6 months after operation.Conclusion Compared with lateral mass screw fixation，arch plate fixation group’s operation time and intraoperative blood loss were not significantly different in the single open-door cervical expansive laminoplasty.The improvement rate of JOA and spinal canal expansion were better than those of lateral mass screw.Arch plate fixation can effectively avoid axial symptoms and re-closing phenomenon and retain the degree of cervical motion.It is a safe and effective method for the treatment of ossification of the posterior longitudinal ligament of the cervical spine.The early clinical effect is satisfactory.

Key words： lateral mass screw fixation arch titanium plate ossification of posterior longitudinal ligament of cervical spine efficacy analysis

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	Li Cheng
	Guo Kaijin
	Li Qiang
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Li Cheng,Guo Kaijin,Li Qiang, et al. Comparison of Arch Titanium Plate Fixation with Lateral Mass Screws and Titanium Bars in the Treatment of Ossification of the Posterior Longitudinal Ligament of the Cervical Spine[J]. sygkzz, 2017, 23(10): 873-878.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2017/V23/I10/873

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