| Objective To investigate the effect of cervical spondylotic myelopathy,especially cervical spinal stenosis,treated with microplate fixation and anchor fixation in expansive open-door laminoplasty.Methods A total of 60 patients with cervical spondylotic myelopathy treated with expansive open-door laminoplasty are applied to from June 2012 to February 2018 in the Inner Mongolia Medical University Affiliated Hospital.They are divided into microplate group and anchor fixation group according to different fixation techniques.Among them,26 cases were treated with microplate group(group A),and the preoperative Japanese Orthopedics Association(JOA)score was 8.77±1.99.In the anchor fixation group(group B),34 patients had a preoperative JOA score of 8.62±1.63.There are no significant differences in gender,age,preoperative JOA score,and preoperative cervical curvature between the two groups(P>0.05).Postoperative follow-up of neurological improvement(JOA score)and calculation of neurological improvement rate,changes of cervical curvature,postoperative angle of opening and the presence of axial symptoms or C5 nerve root paralysis,statistical method was used to analyze the difference of curative effect between two kinds of expansive open-door laminoplasty.Results All cases were followed up for 12-24 months with an average of 18.6 months.The JOA score of group A is 14.35±1.57,the improvement rate of neurological function is(66.46±20.87)%.The JOA score of group B is13.15±1.28,and the improvement rate of neurological function is(52.94±18.04)%.The JOA score of group A is 15.00±0.98,the improvement rate of neurological function is(74.65±13.82)%,the JOA score of group B is 14.15±1.13,and the improvement rate of neurological function is(65.44±17.40)%.At the last follow-up,the JOA score of group A is 15.54(+0.81),the improvement rate of neurological function is(81.35(+11.69)%,the JOA score of group B is 14.88(+0.77),and the improvement rate of neurological function is(73.79(+11.34)%.The neurological function of the two groups improved significantly after surgery,but the improvement of group A is more significant than group B,and the differences are statisticallysignificant(P<0.05).Cervical curvature are 9.77±1.97 mm,9.62±1.81 mm and9.42±1.75 mm at 1 month,12 months and at the last follow-up of the microplate group,and the anchor fixation group are 9.18±1.78 mm,9.00 ±1.44 mm and8.85±1.26 mm,the differences are not statistically significant(P>0.05).The opening angles of vertebral plate in group A are 47.19±11.99°,45.00±11.78°and40.65±11.40° at 1 month,12 months,and at the last followup,group B are 45.26±9.60°,39.35±9.83°,34.09±10.05°.There is no significant loss of the opening angles of vertebral plate between the two groups at 1 month after operation,and the differences are not statistically significant(P>0.05).However,the loss of the opening angles of vertebral plate in the group B at 12 months and the last follow-up are more obvious than the group A.The differences are statistically significant(P < 0.05).After operation,3 patients in group A have residual axial symptoms,the incidence rate is 11.5%,while 9 patients in group B have residual axial symptoms,the incidence rate was 26.5%,the difference is statistically significant(P<0.05).There is no obvious C5 nerve root paralysis after treatment.Only one patient in group B have transient C5 radiculopathy,and the difference is not statistically significant(P>0.05).Conclusions(1)Although both fixation methods can effectively improve neurological symptoms,but the microplate group is better than the anchor group.(2)The loss of cervical curvature and the loss opening angles of vertebral plate are observed after the two fixation methods,but the microplate group is better than the anchor fixation group for the maintenance of the opening angles.(3)The incidence of axial symptoms in the microplate group is significantly lower than anchor fixation group,and its general efficacy is better than anchor fixation method. |
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