Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi
Öz
Amaç: Open-door servikal laminoplasti multipl seviye servikal myelopatisi olan hastalar için standart
cerrahi seçenektir. Cerrahide laminanın bir tarafına lineer laminektomi yapılırken, karşı tarafa menteşe
halini alacak şekilde kemik drillemesi yapılır. Lineer laminektomi yapılan taraf kaldırılırken diğer tarafta
menteşe kırıkları meydana gelebilir. Bu kırıkların oluşmaması için olası risk faktörlerini incelemeyi
amaçladık.
Gereç ve Yöntemler: 2013-2018 yılları arasında open-door servikal laminoplasti operasyonu geçiren
olguların dosyaları, radyolojik görüntüleri, laboratuvar sonuçları retrospektif olarak incelendi.
Bulgular: Çalışmaya opere edilen 54 erkek, 24 kadın olmak üzere 78 hasta dahil edildi. Hastaların
yaş ortalaması 57,8 ± 11,6 idi. Operasyon öncesi hastaların Modifiye JOA (Japanese Orthopedic
Association) servikal miyelopati skorları 16,2 ± 2,1 olarak geldi. Operasyon öncesi kan Ca++
değerlerine bakıldığında 9,3 ± 0,5 mg/dl idi. Hastaların Pavlov oranı ortalaması 0,7 ± 0,2 idi. Laminalar
26 olguda sağ taraftan, 52 olguda sol taraftan açıldı. Toplam 304 lamina açıldı. Operasyon sonrası
çekilen kontrol servikal BT’lerde 42 hastada lamina menteşe kırığı vardı. Menteşe kırığı olmayan hasta
sayısı 36 idi. Toplamda 89 lamina seviyesinde kırık vardı. Cerrahi sonrası çekilen servikal BT’ler
incelendiğinde laminaların açılma açısı (OA) ortalaması 30,6 ± 8,9 derece olarak ölçüldü. Lamina
açılma açısının menteşe kırığına anlamlı ölçüde etki ettiği gözlendi. Lamina menteşe kırığı olan
hastalarda OA 32,3 ± 9 (p<0,05) derece iken, olmayan hastalarda OA ortalama açısı 28,7 ± 8,3
(p<0.05) olarak bulundu.
Sonuç: Open-door servikal laminoplasti sırasında lamina açılma açısının fazlalığı menteşe kırıkları
oluşması olasılığını artırmaktadır. Operasyon öncesi gerekli ölçümlerin yapılması ameliyat sırasında
menteşe kırıklarının meydana gelme riskini azaltacaktır. Bu da hem operasyon sırasında
komplikasyon riskini azaltacak hem de ameliyat sonrası dönemde hasta konforunu artıracaktır.
Anahtar Kelimeler
Kaynakça
- Chen H, Liu H, Zou L, Li T, Gong Q, Song Y, et al. Effect of Mini-plate Fixation on Hinge Fracture and Bony Fusion in Unilateral Open-door Cervical Expansive Laminoplasty. Clin Spine Surg. 2016;29(6):E288-95.
- Byard RW, Langlois N, Gilbert JD. Positive "water test"-an external indicator of base of skull hinge-ring fracture. J Forensic Sci. 2010;55(2):519-20.
- Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy. 2012;28(1):85-94.
- Hirabayashi K, Satomi K. Operative procedure and results of expansive open-door laminoplasty. Spine (Phila Pa 1976). 1988;13(7):870-6.
- Satomi K, Nishu Y, Kohno T, Hirabayashi K. Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy. Spine (Phila Pa 1976). 1994;19(5):507-10.
- Hosono N, Yonenobu K, Ono K. Neck and shoulder pain after laminoplasty. A noticeable complication. Spine (Phila Pa 1976). 1996;21(17):1969-73.
- Steinmetz MP, Resnick DK. Cervical laminoplasty. Spine J. 2006;6(6 Suppl):274S-81S.
- Uematsu Y, Tokuhashi Y, Matsuzaki H. Radiculopathy after laminoplasty of the cervical spine. Spine (Phila Pa 1976). 1998;23(19):2057-62.
- Yonenobu K, Abumi K, Nagata K, Taketomi E, Ueyama K. Interobserver and intraobserver reliability of the japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976). 2001;26(17):1890-4; discussion 5.
- Chen H, Liu H, Deng Y, Gong Q, Li T, Song Y. Multivariate Analysis of Factors Associated With Axial Symptoms in Unilateral Expansive Open-Door Cervical Laminoplasty With Miniplate Fixation. Medicine (Baltimore). 2016;95(2):e2292.
- Cho SH, Lee JH, Chough CK, Joo WI, Park HK, Lee KJ, et al. Hinge Fracture during Cervical Open-door Laminoplasty: Does it Affect Clinical and Radiographic Outcomes? Korean J Spine. 2014;11(2):45-51.
- Lee DH, Kim H, Lee CS, Hwang CJ, Cho JH, Cho SK. Clinical and radiographic outcomes following hinge fracture during open-door cervical laminoplasty. J Clin Neurosci. 2017;43:72-6.
- Park YK, Lee DY, Hur JW, Moon HJ. Delayed hinge fracture after plate-augmented, cervical open-door laminoplasty and its clinical significance. Spine J. 2014;14(7):1205-13.
- Nordin BE. Calcium and osteoporosis. Nutrition. 1997;13(7-8):664-86.
- Zhang X, Zhang Y, Duan D, Xie H. A Novel Drill Navigation Template Combines Preoperative Simulation in Expansive Open-Door Laminoplasty. World Neurosurg. 2018;118:e758-e65.
- Meng Y, Wang X, Chen H, Hong Y, Wu T, Wang B, et al. Risk Factors for Significant Intraoperative Blood Loss During Unilateral Expansive Open-Door Cervical Laminoplasty for Cervical Compressive Myelopathy. World Neurosurg. 2018;114:e1253-e60.
- Lee JH, Chough CK. Risk Factors for Hinge Fracture Associated with Surgery Following Cervical Open-Door Laminoplasty. Korean J Neurotrauma. 2018;14(2):118-22.
- Hur JW, Park YK, Kim BJ, Moon HJ, Kim JH. Risk Factors for Delayed Hinge Fracture after Plate-Augmented Cervical Open-Door Laminoplasty. J Korean Neurosurg Soc. 2016;59(4):368-73.
Evaluation of risk factors affecting development of hinge fracture complications related to open-door cervical laminoplasty technique
Öz
Aim: Open-door cervical laminoplasty is the standard surgical option for patients with multipl levels cervical myelopathy. In this surgical technique, while linear laminectomy is performed on one side of the lamina, bone is drilled to form a hinge on the opposite side. Hinge fractures may occur on the other side while lifting the linear laminectomy side. Our study aimed to examine possible risk factors for preventing these fractures.
Materials and Methods: The patients’ files, radiological images, and laboratory results who underwent cervical laminoplasty between 2013-2018 were retrospectively analyzed.
Results: A total of 78 patients, 54 males and 24 females, were included in the study. The mean age of the patients was 57.8±11.6 years. The mean modified Japanese Orthopedic Association (JOA) cervical myelopathy scores of the patients before the operation were 16.2±2.1. When the pre-operative blood Ca values were examined, the mean value was 9.3±0.5 mg/dl. The mean Pavlov ratio of the patients was 0.7±0.2. Laminas were opened from the right side in 26 cases and from the left side in 52 cases. A total of 304 laminae were opened. In post-operative control cervical CTs, 42 patients had lamina hinge fractures, and the number of patients without hinge fracture was 36. There were 89 fractures in total at the lamina level. When post-operative cervical tomography images were examined, the mean opening angle (OA) of the laminas was 30.6±8.9 degrees. The opening angle of the lamina was determined to affect the hinge fracture significantly. While OA was 32.3±9 degrees in patients with lamina hinge fracture, it was found to be 28.7±8.3 in patients without fractures (p <0.05).
Conclusion: During open-door cervical laminoplasty, the excessive opening angle of the lamina increases the possibility of hinge fractures. Pre-operative necessary measurements will reduce the risk of hinge fractures during surgery. This evaluation will reduce the risk of complications during the operation and increase patient comfort in the post-operative period.
Anahtar Kelimeler
Kaynakça
- Chen H, Liu H, Zou L, Li T, Gong Q, Song Y, et al. Effect of Mini-plate Fixation on Hinge Fracture and Bony Fusion in Unilateral Open-door Cervical Expansive Laminoplasty. Clin Spine Surg. 2016;29(6):E288-95.
- Byard RW, Langlois N, Gilbert JD. Positive "water test"-an external indicator of base of skull hinge-ring fracture. J Forensic Sci. 2010;55(2):519-20.
- Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy. 2012;28(1):85-94.
- Hirabayashi K, Satomi K. Operative procedure and results of expansive open-door laminoplasty. Spine (Phila Pa 1976). 1988;13(7):870-6.
- Satomi K, Nishu Y, Kohno T, Hirabayashi K. Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy. Spine (Phila Pa 1976). 1994;19(5):507-10.
- Hosono N, Yonenobu K, Ono K. Neck and shoulder pain after laminoplasty. A noticeable complication. Spine (Phila Pa 1976). 1996;21(17):1969-73.
- Steinmetz MP, Resnick DK. Cervical laminoplasty. Spine J. 2006;6(6 Suppl):274S-81S.
- Uematsu Y, Tokuhashi Y, Matsuzaki H. Radiculopathy after laminoplasty of the cervical spine. Spine (Phila Pa 1976). 1998;23(19):2057-62.
- Yonenobu K, Abumi K, Nagata K, Taketomi E, Ueyama K. Interobserver and intraobserver reliability of the japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976). 2001;26(17):1890-4; discussion 5.
- Chen H, Liu H, Deng Y, Gong Q, Li T, Song Y. Multivariate Analysis of Factors Associated With Axial Symptoms in Unilateral Expansive Open-Door Cervical Laminoplasty With Miniplate Fixation. Medicine (Baltimore). 2016;95(2):e2292.
- Cho SH, Lee JH, Chough CK, Joo WI, Park HK, Lee KJ, et al. Hinge Fracture during Cervical Open-door Laminoplasty: Does it Affect Clinical and Radiographic Outcomes? Korean J Spine. 2014;11(2):45-51.
- Lee DH, Kim H, Lee CS, Hwang CJ, Cho JH, Cho SK. Clinical and radiographic outcomes following hinge fracture during open-door cervical laminoplasty. J Clin Neurosci. 2017;43:72-6.
- Park YK, Lee DY, Hur JW, Moon HJ. Delayed hinge fracture after plate-augmented, cervical open-door laminoplasty and its clinical significance. Spine J. 2014;14(7):1205-13.
- Nordin BE. Calcium and osteoporosis. Nutrition. 1997;13(7-8):664-86.
- Zhang X, Zhang Y, Duan D, Xie H. A Novel Drill Navigation Template Combines Preoperative Simulation in Expansive Open-Door Laminoplasty. World Neurosurg. 2018;118:e758-e65.
- Meng Y, Wang X, Chen H, Hong Y, Wu T, Wang B, et al. Risk Factors for Significant Intraoperative Blood Loss During Unilateral Expansive Open-Door Cervical Laminoplasty for Cervical Compressive Myelopathy. World Neurosurg. 2018;114:e1253-e60.
- Lee JH, Chough CK. Risk Factors for Hinge Fracture Associated with Surgery Following Cervical Open-Door Laminoplasty. Korean J Neurotrauma. 2018;14(2):118-22.
- Hur JW, Park YK, Kim BJ, Moon HJ, Kim JH. Risk Factors for Delayed Hinge Fracture after Plate-Augmented Cervical Open-Door Laminoplasty. J Korean Neurosurg Soc. 2016;59(4):368-73.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 13 Eylül 2021 |
| Gönderilme Tarihi | 25 Ekim 2020 |
| Yayımlandığı Sayı | Yıl 2021 |