C3～C7与C3～C6节段单开门椎管扩大成形术后轴性痛的差异

The difference of axial pain between patients accepting C3-C7 or C3-C6 one-door-open laminoplasty

中文关键词:  轴性痛  颈后路单开门椎管扩大成形术

英文关键词:Axial pain  One-door-open laminoplasty

中文摘要:

  【摘要】 目的：研究保留C7棘突、椎板及其附着颈后肌群能否减少单开门椎管扩大成形术后轴性痛的发生。方法：纳入2010年4月～2011年4月在我院接受开门节段为C3～C6（A组，26例）或C3～C7（B组，27例）颈后路单开门椎管扩大成形术的患者53例，记录随访时（通过门诊和电话随访）两组病例神经功能恢复及颈椎活动度变化情况，同时比较两组患者术后轴性痛发生的时间、初始疼痛程度VAS评分及完全缓解所需时间的差异。结果：两组患者术后1年随访时JOA评分、神经功能改善率、颈椎活动度及颈椎活动度改变率均无明显统计学差异（P>0.05）。A组轴性痛的发生率为30.7%（8/26），其中轻度5例，中度3例；B组发生率为33.3%（9/27），其中轻度4例，中度4例，重度1例，两组轴性痛发生率和初始疼痛程度分级均无明显统计学差异（P>0.05）。A组病例初始VAS评分平均为3.0分，B组为4.4分，两组间差异有显著性（P<0.05）；A组病例疼痛出现时间平均为术后57.3d，B组为25.4d，两组间差异显著（P<0.05）；A组疼痛完全缓解的时间为术后99.1d，B组为165.9d，两组间有统计学差异（P<0.05）。结论：与传统C3～C7颈后路单开门椎管扩大成形术相比，C7棘突、椎板及其后方附着颈后肌群的保留并不影响术后颈椎活动度和神经功能的恢复，且可以降低初始轴性痛的VAS评分，并延迟轴性痛发生时间、减少完全缓解所需时间，可提高患者生活质量。

英文摘要:

  【Abstract】 Objectives: To decide whether the preservation of C7 lamina, spinous process, and accessory muscles can reduce the incidence of axial pain after one-door-open laminoplasty. Methods: 53 patients who underwent the modified laminoplasty with mini-plate from April 2010 to April 2011 in our hospital were included and divided into 2 groups according to the laminas that lifted from C3 to C6(group A, 26 cases) or from C3 to C7(group B, 27 cases). The follow-up JOA score and cervical range of motion(ROM) were compared between 2 groups. 53 patients were surveyed by clinic visit or telephone connection to ensure whether they got axial pain(AP), and to record the initial severity grade, VAS score, the onset and the duration for complete remission. Then these data were analyzed to find out the differences between 2 groups. Results: There were no significant differences in JOA score, neurologic recovery rate(NR), cervical ROM and change of ROM between 2 groups at 1 year follow-up(P>0.05). The AP incidence rate in group A was 30.7%(8/26), including 5 mild and 3 moderate of AP grade; the axial pain incidence rate in group B was 33.3%(9/27), including 4 mild, 4 moderate and 1 severe of AP grade. There was no significant difference between two groups(P>0.05). The VAS between 2 groups was significantly different, with value 3.0 in group A and 4.4 in group B(P<0.05). The onset of pain and complete remission in group A was 57.3 days and 99.1 days separately, and 25.4 days and 165.9 days in group B, with both significant differences(P<0.05). Conclusions: The preservation of C7 lamina, spinous process and its accessory muscles does not influence the recovery of neural function, reservation of cervical range of motion and incidence of axial pain. And it can reduce the initial VAS score, delay the onset, decrease the duration of pain process, and improve the life quality of patients. 【Key words】 Axial pain; One-door-open laminoplasty