The Clinical Research Of Expansive Open-door Cervical Laminoplasty In Situ Reconstruction Of Extensor Muscle Insertion On The Spinous Process Of Axis Combined With Titanium Miniplates Internal Fixation

Objective:To evaluate efficacy and relevant problems of in situ reconstruction of extensor muscle insertion on the spinous process of axis combined with titanium miniplates internal fixation in expansive open-door cervical laminoplasty so as to improve surgical treatment effect.Methods:From October 2010 to September 2013,a total of 124 patients who suffered cervical canal stenosis were treated by expansive open-door laminoplasty.A total of 60 patients who suffered cervical canal stenosis were treated by expansive open-door laminoplasty with in situ reconstruction of extensor muscle insertion on the spinous process of axis combined with titanium miniplates internal fixation(reconstruction group).A total of 64 patients with classicopen-door combined with titanium miniplates internal fixation(control group).Changes of cervical curvature index(CI)and range of motion(ROM)were calculated using data from preoperative and postoperative cervical spine X-ray examinations.Clinical function was scored using the Japanese Orthopedics Association Scoring System(JOA)and the neck disability index(NDI).Results:Reconstruction group,the mean CI before the operation and at 1 year postoperation were 10.49%± 3.93%and 14.14%± 2.85%(t=8.07,P<0.05).The mean ROM values were 43.350 ± 7.550 before the operation,34.830 ± 7.410 at 1 year postoperation(t=-6.78,P<0.05).The NDI scores decreased from 19.42 ± 4.12 to 7.37 ±2.58(t=-17.94 P<0.05),and the JOA scores increased from 8.87 ± 1.99 to 13.55 ± 1.72,representing significant improvement(t=-13.42,P<0.05).Control group,the mean CIbefore the operation and at 1 year postoperation were 10.56%± 4.88%and 12.43%± 3.36%(t=7.09,P<0.05).The mean ROM values were 43.350 ±7.550 before the operation,34.830± 7.410 at 1 year postoperation(t=-14.45,P<0.05).The NDI scores decreased from 19.42 ± 4.12 to 7.37 ± 2.58(t=-20.65,P<0.05),and the JOA scores increased from 8.87 ± 1.99 to 13.55 ± 1.72,representing significant improvement(t=6.62,P<0.05).Preoperative reconstruction group and control group,there was no significant difference in CI(t=0.09,P>0.05),no significant difference was found in ROM(t=1.35,P>0.05),no significant difference was found in JOA scores(t=0.43 P>0.05),no significant difference was found in NDI scores(t=1.96,P>0.05).Postoperative reconstruction group and control group,there was showing significant difference in CI(t=2.89,P<0.05),significant difference was found in ROM(t=2.38,P<0.05),significant difference was found in JOA scores(t=3.20,P<0.05),significant difference was found in NDI scores(t=3.34,P<0.05).In reconstruction group and control group,there was one case had postoperative C5 nerve root palsy and completely recovered one month later.Neither collapse nor door closure in the open-door side occurred in any of the patients.Conclusions:Expansive open-door cervical laminoplasty with in situ reconstruction of extensor muscle insertion on the spinous process of axis combined with titanium miniplates internal fixation is a safe and effective surgical method,and can effectively decrease postoperative complications and achieve satisfactory clinical results.