术前颈椎曲度与椎管扩大成形术后脊髓后移程度及疗效的相关性

Correlation between cervical curvature and spinal cord shift, surgical outcome after expansive open-door laminoplasty

中文关键词:  椎管扩大成形术  颈椎曲度  后凸畸形  脊髓后移  疗效

英文关键词:Laminoplasty  Cervical curvature  Kyphosis  Spinal cord shift  Outcome

中文摘要:

  【摘要】 目的：观察术前不同颈椎曲度的慢性压迫性颈脊髓病患者行单开门椎管扩大成形术后脊髓后移的距离及临床疗效，探讨颈椎曲度与椎管扩大成形术后脊髓后移程度及临床疗效的相关性。方法：选取我院2005年1月~2011年12月采用传统棘突、小关节囊悬吊法单开门椎管扩大成形术治疗并获得完整随访资料的慢性压迫性颈脊髓病患者共63例，包括脊髓型颈椎病26例，颈椎后纵韧带骨化症（OPLL）20例，发育性颈椎管狭窄合并颈脊髓病17例，均因多节段颈椎间盘退变突出、后纵韧带骨化导致多节段颈脊髓受压或合并发育性颈椎管狭窄而采用单开门椎管扩大成形术治疗。根据术前X线片上颈椎曲度将患者分为后凸畸形组（n=16）、曲度变直组（n=18）和曲度正常组（n=29），在术前、术后颈椎MRI T2加权像中心矢状位片上测量并计算C3~C7各节段脊髓后移距离（posterior shift of center of spinal cord，PCS），比较三组患者C3~C7各节段PCS的差异；评价术前和末次随访时神经功能（JOA评分），计算并比较三组患者末次随访时JOA评分改善率及差异。结果：三组患者的年龄、性别比、病程、随访时间、病种构成和术前JOA评分等无统计学差异（P>0.05）。术后各节段脊髓均有明显后移，三组患者C3~C7五个节段的PCS均无统计学差异（P>0.05）。随访时间15~90个月，平均47±24个月，三组患者末次随访时平均JOA改善率分别为59.81%、69.25%、54.44%，差异无统计学意义（P>0.05）。C5水平脊髓后移距离与末次随访时JOA改善率无线性相关关系（r=0.110，P=0.390）。结论：术前不同颈椎曲度的慢性压迫性颈脊髓病患者椎管扩大成形术后脊髓均能后移，并可取得较好的临床疗效；椎管扩大成形术后脊髓后移程度、神经功能改善率与术前颈椎曲度无明显相关性。

英文摘要:

  【Abstract】 Objectives: To observe the spinal cord shift and surgical outcome of different types of cervical curvature after expansive open-door laminoplasty for cervical myelopathy, and to investigate the relationship between cervical curvature and spinal cord shift. Methods: 63 cases of cervical myelopathy undergoing traditional expansive open-door laminoplasty between January 2005 and December 2011 were reviewed retrospectively, the pathogenesis included cervical spondylotic myelopathy(26 cases), ossification of posterior longitudinal ligament(OPLL, 20 cases) and developmental cervical spinal stenosis(17 cases). Traditional expansive open-door laminoplasty was performed because of multisegmental disc disease, multilevel OPLL or developmental cervical stenosis. All cases were divided into three groups according to the cervical curvature: the kyphosis group(n=16), the straight group(n=18) and the normal alignment group(n=29). The posterior shift of center of spinal cord(PCS) at each level of laminoplasty(C3-C7) was measured and calculated through the midsagittal images of MRI T2-weighted before and after surgery. Statistic analysis was performed to analyze the difference of PCS at each level(C3-C7) among three groups. The neurofunction for each patient was estimated by using the Japanese Orthopedic Association(JOA) score before surgery and at final follow-up, and the JOA recovery rate was calculated. Statistic analysis was performed to analyze the difference of the JOA recovery rate at final follow-up among three groups. Results: There was no statistical difference in the age, sex ratio, duration of symptoms, entity, follow-up time or the preoperative JOA score(P>0.05). Posterior migration of spinal cord was observed in all three groups, and there was no significant difference with respect to the mean PCS at C3-C7 level among three groups(P>0.05). The mean follow-up was 47±24(range 15-90) months, and the mean JOA recovery rate at final follow-up of each group was 59.81%, 69.25% and 54.44% respectively, which showed no statistical difference(P>0.05). No linear correlation was found between the JOA recovery rate at latest follow-up and the postoperative PCS at C5 level(r=0.110, P=0.390). Conclusions: The spinal cord shift can be observed in patients regardless of different types of preoperative cervical curvature, and all showed good neurofunctional recovery.