微型钛板固定与侧块螺钉固定在颈椎后路单开门椎管扩大成形术中的对比研究

Comparative Study of Mini-Plate Fixation and Lateral Mass Screw Fixation in Cervical Posterior Open-Door Laminoplasty

摘要: 目的：评估颈椎后路单开门椎管扩大成形微型钛板与侧块螺钉固定术后，颈椎矢状位参数变化与疗效的相关性分析。方法：回顾性分析2022年9月至2024年1月脊髓型颈椎病的患者29例，其中行微型钛板固定的手术患者18例，侧块螺钉固定患者11例，所有患者均行C3~C6后路单开门椎管扩大成形术。随访时间为术后12个月，记录手术前后日本骨科矫形协会评分(JOA)、疼痛视觉模拟评分(VAS)、颈部功能障碍指数(NDI)评估颈椎功能状态。术前、术后和随访时行颈椎正侧位X线片、CT三维重建和MRI检查，测量术前及末次随访时的颈椎矢状位参数，包括C2~C7 Cobb角、C2~C7矢状面轴向距离(sagittal venical axis, SVA)和T1倾斜角。结果：两组手术末次随访时JOA评分、VAS评分及NDI评分均较术前有明显改善(P < 0.05)，但末次随访时比较两组手术C2~C7 Cobb角、C2~C7 SVA、T1 Slope、JOA评分、VAS评分、NDI评分差异无统计学意义(P > 0.05)。微型钛板固定组C2~C7 Cobb角由术前19.08 ± 2.70减小至14.76 ± 3.40，差异有统计学意义(P < 0.05)，C2~C7 SVA由术前19.37 ± 5.51增加至24.15 ± 5.32，差异有统计学意义(P < 0.05)，T1 Slope由术前22.46 ± 4.18增加值25.83 ± 6.24，差异有统计学意义(P < 0.05)。侧块螺钉固定组C2~C7 Cobb角由术前18.32 ± 4.45减小至15.21 ± 2.59，差异无统计学意义(P = 0.059)，C2~C7 SVA由术前19.67 ± 2.89增加至22.79 ± 2.89，差异无统计学意义(P = 0.052)，T1 Slope由术前23.35 ± 7.70增加值28.11 ± 6.16，差异无统计学意义(P = 0.117)。Pearson相关分析结果显示微型钛板固定组术后T1 Slope与C2~C7 Cobb角、C2~C7 SVA呈正相关(r = 0.434, P < 0.05; r = 0.376, P < 0.05)，术后NDI评分与C2~C7 Cobb角、C2~C7 SVA及T1 Slope呈正相关(r = 0.417, P < 0.05; r = 0.328, P < 0.05; r = 0.419, P < 0.05)，侧块螺钉固定组术后NDI评分与C2~C7 Cobb角、C2~C7 SVA及T1 Slope也均呈正相关(r = 0.338, P < 0.05; r = 0.334, P < 0.05; r = 0.311, P < 0.05)，其余各组数据之间无相关性(P > 0.05)。结论：微型钛板固定与侧块螺钉固定的颈椎后路单开门手术治疗脊髓型颈椎病均有确切的疗效。微型钛板组手术前后矢状位参数存在明显差异，但末次随访时两组颈椎矢状位参数无显著差异，矢状位参数变化与患者疗效无显著相关性。

Abstract: Objective: To evaluate the correlation between changes in cervical sagittal parameters and clinical efficacy following posterior open-door laminoplasty using mini-plate fixation versus lateral mass screw fixation for cervical spondylotic myelopathy (CSM). Methods: A retrospective analysis was conducted on 29 CSM patients treated between September 2022 and January 2024. Among them, 18 underwent C3~C6 posterior open-door laminoplasty with mini-plate fixation, and 11 received lateral mass screw fixation. All patients were followed up for 12 months. Preoperative and postoperative functional outcomes were assessed using the Japanese Orthopaedic Association (JOA) score, Visual Analogue Scale (VAS), and Neck Disability Index (NDI). Cervical sagittal parameters, including the C2~C7 Cobb angle, C2~C7 sagittal vertical axis (SVA), and T1 slope, were measured on X-ray, CT, and MRI scans before surgery and at the final follow-up. Results: Both groups showed significant improvement in JOA, VAS, and NDI scores at the final follow-up compared to preoperative values (P < 0.05). However, no statistically significant differences were observed between the two groups in C2~C7 Cobb angle, SVA, T1 slope, or functional scores at the final follow-up (P > 0.05). In the mini-plate group, the C2~C7 Cobb angle decreased significantly from 19.08˚ ± 2.70˚ to 14.76˚ ± 3.40˚ (P < 0.05), SVA increased from 19.37 ± 5.51 mm to 24.15 ± 5.32 mm (P < 0.05), and T1 slope increased from 22.46˚ ± 4.18˚ to 25.83˚ ± 6.24˚ (P < 0.05). In the lateral mass screw group, the C2–C7 Cobb angle decreased from 18.32˚ ± 4.45˚ to 15.21˚ ± 2.59˚ (P = 0.059), SVA increased from 19.67 ± 2.89 mm to 22.79 ± 2.89 mm (P = 0.052), and T1 slope increased from 23.35˚ ± 7.70˚ to 28.11˚ ± 6.16˚ (P = 0.117), with no statistically significant changes. Pearson correlation analysis revealed that in the mini-plate group, postoperative T1 slope was positively correlated with C2~C7 Cobb angle and SVA (r = 0.434, P < 0.05; r = 0.376, P < 0.05), and NDI scores correlated positively with Cobb angle, SVA, and T1 slope (r = 0.417, 0.328, 0.419; P < 0.05). Similarly, in the lateral mass screw group, NDI scores correlated positively with these parameters (r = 0.338, 0.334, 0.311; P < 0.05). There was no correlation between the other groups of data (P > 0.05). Conclusion: Both mini-plate and lateral mass screw fixation in posterior open-door laminoplasty demonstrate efficacy for CSM. Although sagittal parameters changed significantly in the mini-plate group postoperatively, no intergroup differences were observed at the final follow-up. Changes in sagittal alignment did not significantly correlate with clinical outcomes.