赵雪枝　黄长智　陈小雁

[摘要] 目的 探讨颈后路单开门椎管扩大成形ARCH钛板内固定术的护理配合。 方法 选取本院2010年11月～2013年11月的20例颈椎管狭窄症患者作为研究对象，对术前动力系统、手术体位、Mayfield头架的摆放及术中涉及的器械、动力系统的使用及围手术期护理等问题进行总结。 结果 20例患者手术顺利，无一例因手术体位和动力系统原因影响手术进程。术后均未出现脊髓损伤、血肿等并发症。术后6～12个月随访，未发现内固定物松动、移位、断裂等现象，患者神经功能恢复良好。 结论 颈后路单开门椎管扩大成形术是目前治疗颈椎管狭窄症较好的一种手术方式。掌握Mayfield头架的使用、手术体位的摆放，熟悉手术步骤、动力系统准备和使用及做好围术期护理有助于手术的顺利完成和患者的早期康复。

[关键词] 颈椎管狭窄症；单开门椎管扩大成形术；ARCH钛板；护理

[中图分类号] R473.6 [文献标识码] A [文章编号] 1674-4721（2015）06（c）-0185-04

[Abstract] Objective To explore the cooperation and nursing of the cervical posterior single door vertebral canal expanded forming with ARCH plate fixation surgery. Methods 20 cases with cervical stenosis from November 2010 to November 2013 in our hospital were selected as the research object，preoperative dynamic system，surgical position，the placement of Mayfield skull traction frame and involved in the surgery of equipment，the use of the dynamic system and perioperative nursing were summarized. Results 20 cases were operated successfully，and there was no case affected the surgical process due to surgical position and dynamic system.There was no complication such as spinal cord injury or hematoma.All patients received follow-up for 6～12 months，without the phenomenons such as internal fixation loosening or displacement or fractures.All patients nervous function recovered well. Conclusion Cervical posterior single door vertebral canal expanded forming is an effective treatment in the case of cervical spinal stenosis disease.To master the use of Mayfield skull traction frame，the placement of surgical position，familiar with the surgical steps，preparation and use of dynamic system and perioperative nursing care can be conducive to the successful completion of the surgery and early recovery of patients.

[Key words] Cervical spinal stenosis；Single open-door laminoplasty；ARCH steel plate；Nursing

颈椎管狭窄症常见于中老年人，多由发育性颈椎管狭窄、退变性颈椎管狭窄、多节段颈椎间盘突出、颈椎后纵韧带骨化等因素造成一个或多个颈椎节段椎管狭窄，导致脊髓血液循环障碍、脊髓及神经根压迫，进而出现相应的脊髓、神经根症状[1-2]。颈后路单开门椎管扩大成形术是目前学术界公认的治疗严重多节段颈椎管狭窄症的经典手术之一[3-6]，该术式通过直接掀开椎板，扩大椎管的矢状径来解除椎管前、后方对脊髓、神经根的压迫，进而达到减压的目的。该手术减压较为彻底，手术相对安全，术后效果肯定，但术后有可能发生“再关门”现象，重新出现颈椎管狭窄症状[7]。……