聂邦旭 周曙光 段洪 胡军 胡志军 袁晓峰 蔡云华 张云峰

摘要：目的：探讨锚定钉在颈椎单开门椎管扩大术（expansive open door laminoplasty，ELAP）治疗多节段脊髓型颈椎病中的临床应用价值。方法：2007年1月～2013年3月，采用颈椎单开门椎管扩大术治疗多节段脊髓型颈椎病39例，男17例，女22例。年龄48～78岁，平均62.4岁。病程1.6～6年，平均2.8年。4节段24例，5节段15例。24例合并发育性或退变性颈椎管狭窄，均有颈脊髓受压症状，JOA评分3～11分，平均7.1±2.1分。均行颈椎單开门椎管扩大术，开门节段均为C3～C7，均采用锚定钉固定，固定节段为C3-7。结果：锚定钉均顺利置入，手术时间60～90min，平均70min。3例术后有颈肩部疼痛，给予对症处理1个月后疼痛消失。术后随访9月-30月，平均23月，末次随访时JOA评分10～16分，平均13.1±1.5分，与术前比较差异有统计学意义（P<0.01），平均改善率为（69.5±5.5）%，优良率为89.7%。X线片检查显示颈椎曲度基本正常，椎管中矢状径与椎体中矢状径比值平均为1.2，锚钉无松动，无颈椎不稳及关门。结论：颈椎后路单开门椎管扩大成形术治疗颈椎管狭窄合并脊髓型颈椎病是一种有效、简单可靠的方法，可避免“关门”，临床疗效满意，且费用也较少。

关键词：颈椎管狭窄症；单开门；椎管扩大术；锚定钉

Abstract：Objective：To investigate the clinical application value of anchoring nails in open door expansive laminoplasty treating the cervical spondylotic myelopathy.Method：From January 2007 to March 2013，39 patients with cervical spondylotic myelopathy received operations of the cervical open door expansive laminoplasty.Among them，there were 17 male patients and 22 female patients.Their ages ranged from 48 to 78 years with a mean age of 62.4 years.The course of disease ranged from 1.6 to 6 years and a mean was 2.8 years.4 segments were involved in 24 patients，5 segments in 15 patients and 20 patients combined with developmental or degenerative cervical spinal stenosis.All patients had clinical symptom of cervical cord compression.The JOA scores were 3-11 points and a mean was 7.1±2.1 points before the operation.All of them received operations of cervical expansive laminoplasty，the segments were from C3 to C7，and C3-C7 segments were anchorred with the anchoring nails.Result：During the operation，all nails were smoothly placed，The mean operative time was 70min and ranged from 60min to 90min.There was 3 patients having neck and shoulder pain after operation，and the pain disappeared with symptomatic treatment of 1 months.All patients were obtained follow-up for 9-30 months with an average of 23.5 months.The JOA scores were 10-16 points and a mean was 13.1±1.5 points at the last follow-up after operation.There were statistically significant differences compared with the results before operatin （P<0.01）.The average improvement rate was （69.5±5.5）% and the rate of excellent and good results was 89.7%.Postoperative radiograph showed，the physiological curvature of cervical vertebra was basically normal，and the anchoring nails had no loosening and there was no case with cervical instability and door re-closure.Conclusion：The anchoring nail method is simple and reliable during the expansive laminoplasty treating the cervical spondylotic myelopathy.It can avoid "door reclosure"，and clinical efficacy is satisfactory and expend less than others methods.

Keywords：Cervical spondylotic myelopathy；Open door ；Expansive laminoplasty；Anchoring nail

脊髓型颈椎病（cervical spondylotic myelopathy，CSM）在临床常见，诊断一旦确立，大多数学者认为应尽早手术减压治疗。可根据患者的具体情况采用不同的手术入路。经后路单开门椎管扩大术可以为脊髓提供后移空间， 使大多数病例解除脊髓壓迫。开门椎板多采用丝线缝合等方法固定，但存在关门和操作不够简便的弊病。2007年1月～2013年3月，我们在颈椎单开门椎管扩大术治疗多节段脊髓型颈椎病时应用锚定钉固定开门椎板，取得了满意疗效，报告如下。

1.一般资料

共治疗39例多节段CSM患者，男17例，女22例。年龄48～78岁，平均62.4岁。病程1.6～6年，平均2.8年。4节段24例，5节段15例。24例合并发育性或退变性颈椎管狭窄，其中11例发育性颈椎管狭窄患者颈椎管中矢状径与颈椎体中矢状径的比值平均为0.69±0.04，至少有3个节段低于0.75。……