保留双侧半棘肌单开门与传统单开门椎管扩大成形术治疗多节段颈脊髓压迫症的疗效比较

Clinical effect comparison between traditional open-door laminoplasty and reserved bilateral semispinalis modified open-door laminoplasty for multiple segmental cervical spinal cord compression syndrome

中文关键词:  多节段颈脊髓压迫症  单开门椎管扩大成形术  轴性症状  颈椎活动度  颈椎曲度

英文关键词:Multiple segmental cervical spinal cord compression  Single open-door laminoplasty  Axial symptoms  Cervical range of motion  Cervical curvature

中文摘要:

  【摘要】 目的：比较保留双侧半棘肌的改良颈椎单开门与传统单开门椎管扩大成形术治疗多节段颈脊髓压迫症的疗效。方法：回顾分析2013年1月～2014年5月在我科行颈椎单开门椎管扩大成形术的66例多节段颈脊髓压迫症患者的临床资料。均行C3～C6单开门椎管扩大成形术，按手术方式分为保留C2、C7双侧半棘肌止点的传统单开门椎管扩大成形术（传统组）36例和保留双侧半棘肌的改良单开门椎管扩大成形术（改良组）30例。记录两组手术时间、术中出血量，记录术前、术后3个月及末次随访时两组病例的视觉模拟评分法（visual analogue scale/score，VAS）评分、JOA评分、颈部功能障碍指数（neck disability index，NDI）评分、颈椎总活动度（ranges of motion，ROM）、颈椎曲度及术后轴性症状的严重程度。结果：传统组手术时间为140.49±36.57min，改良组为122.35±46.57min，差异无统计学意义（P＞0.05）。传统组术中出血量为233.66±165.39ml，改良组为281.18±208.11ml，差异无统计学意义（P＞0.05）。传统组2例、改良组1例患者出现C5神经根麻痹，给予甲基强的松龙、营养神经药物等治疗后，症状明显好转。术后无脊髓损伤、门轴断裂、脑脊液漏、硬膜外血肿、感染，无内置物松动或断裂。两组患者均获随访，随访时间12～24个月，传统组随访时间为17.10±3.57个月，改良组为16.40±2.57个月，差异无统计学意义（P＞0.05）。传统组末次随访时JOA评分改善率为（71.36±8.14）％，改良组为（72.95±14.41）％，差异无统计学意义（P＞0.05）。NDI评分，术前及术后3个月传统组与改良组比较无统计学差异（P＞0.05），末次随访时组间差异有统计学意义（P＜0.05），组内比较术前及末次随访时NDI评分差异有统计学意义（P＜0.05）。VAS评分，术前组间比较无统计学差异（P＞0.05），但术后3个月及末次随访时组间差异有统计学意义（P＜0.05），组内术前及末次随访时VAS评分差异有统计学意义（P＜0.05）。末次随访时，传统组颈椎曲度较术前减少3.73°±1.38°，改良组较术前减少1.47°±1.01°，差异有统计学意义（P＜0.05）；传统组ROM较术前减少6.63°±2.09°，改良组较术前减少4.53°±1.70°，差异有统计学意义（P<0.05）。传统组11例（30.56％）、改良组1例（3.33％）术后发生轴性症状或加重，组间比较差异有统计学意义（P<0.05）。结论：与传统单开门手术相比，保留双侧半棘肌的单开门椎管扩大成形术在治疗多节段颈脊髓压迫症时，可最大限度保留颈椎后方结构，减少轴性症状的发生率和颈椎曲度及ROM的丢失。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical effect of traditional open-door laminoplasty and reserved bilateral semispinalis modified open-door laminoplasty for multiple segmental cervical spinal cord compression syndrome. Methods: From January 2013 to May 2014, The data of 66 cases with multiple segmental cervical spinal canal compression syndrome who underwent open-door laminoplasty in our hospital were retrospectively analyzed． Among them, 36 cases were treated by traditional open-door laminoplasty, the bilateral of C2 and C7 spinous ligaments and muscle tissue attachment were retained(tradition group). The other 30 patients underwent modified open-door laminoplasty together with preservation of bilateral of the semispinalis cervicis(improved group). Operation time and intraoperative blood loss were recorded． Visual analogue scale/score(VAS), Japanese Orthopaedic Association(JOA) score(17-score method), neck disability index(NDI), cervical curvature, range of motion of cervical vertebra and axial symptom severity were compared and analyzed before operation, three months after operation and at final follow-up． Results: The operation time was 140.49±36.57min in tradition group and 122.35±46.57min in improved group(P＞0.05). The intraoperative blood loss was 233.66±165.39ml in tradition group and 281.18±208.11ml in improved group(P＞0.05)． And no spinal cord injury, door shaft fracture, cerebrospinal fluid leakage, epidural hematoma, infection, implant loosening or breakage and other complications were noted in both groups. Two patients in tradition group and one patient in improved group were complicated with C5 nerve root palsy, which was alleviated after correspondent treatment. A total of 66 patients were followed up for 12-24 months, with a mean of 17.10±3.57 months in the tradition group and 16.40±2.57 months in the improved group, no significant difference was found between the two groups(P＞0.05). There was no significant difference in the recovery rate of JOA between 2 groups at last follow-up(P>0.05). No significant difference was found between 2 groups with respect to NDI score at preoperation and three months after operation(P>0.05), but at last follow-up, there was significant difference between two groups(P＜0.05), as well as between preoperation and last follow-up with respect to NDI score in each group(P＜0.05). No significant difference was found between 2 groups with respect to VAS score at preoperative(P＞0.05), but at three months after operation and last follow-up, there were significant differences between 2 groups(P＜0.05), as well as preoperative and last follow-up with respect to VAS score in each group(P＜0.05). At last follow-up, the cervical curvature decreased 3.73°±1.38° in tradition group and 1.47°±1.01° in improved group(P＜0.05). The decrease degree of neck range of motion was 6.63°±2.09° in tradition group and 4.53°±1.70° in improved group at last follow-up(P＜0.05). Postoperative development or deterioration of axial symptoms occurred in 30.56％ of patients in tradition group and 3.33％ of patients in improved group, which showed significant difference(P＜0.05)． Conclusions: Compared to the traditional single-door operation, this new modified open-door laminoplasty procedure retains the integrity of cervical rear structure and decreases the incidence of axial symptoms, loss of cervical curvature and range of neck motion.