颈椎后路改良单开门椎管扩大成形术治疗多节段脊髓型颈椎病的疗效分析

Modified posterior cervical one-open-door laminoplasty for the treatment of multi-segment cervical spondylotic myelopathy

中文关键词:  脊髓型颈椎病  单开门椎管扩大成形术  椎板切除术  轴性症状

英文关键词:Cervical spondylotic myelopathy  Posterior cervical open-door laminoplasty  Laminectomy  Axial symptoms

中文摘要:

  【摘要】 目的：探讨颈椎后路改良单开门椎管扩大成形术治疗多节段脊髓型颈椎病的临床效果。方法：回顾性分析2013年6月~2015年12月采颈椎后路单开门椎管扩大成形术治疗并获得随访的多节段脊髓型颈椎病患者，均采用相同的微型钛板固定单开门椎板，其中21例（男17例，女4例，年龄66.2±10.0岁）采用改良单开门椎管扩大成形术（改良组），39例（男36例，女3例，年龄57.3±10.5岁）采用传统单开门椎管扩大成形术（传统组），收集两组患者手术时间、术中出血量、术后住院时间、手术费用，随访两组患者神经功能改善情况、颈椎曲度、颈椎曲度指数、颈椎活动度及轴性症状等，并进行比较。结果：两组患者性别、年龄、病程、手术时间、术中出血量、术后住院时间均无显著性差异（P＞0.05），两组手术费用比较有显著性差异，改良组平均手术费用明显低于传统组（P＜0.05）。术后随访12～24个月，术后12个月两组患者均达到骨性融合，两组神经功能均明显改善，JOA评分改善率改良组为（60.46±9.65）%，传统组为（46.41±24.33）%，两组比较无显著性差异（P＞0.05）。改良组术后12个月时颈椎曲度丢失4.7°±1.9°，颈椎曲度指数丢失（3.09±.14）%，颈椎活动度丢失7.3°±2.3°；传统组颈椎曲度丢失8.9°±5.6°，颈椎曲度指数丢失（6.27±3.42）%，颈椎活动度丢失13.0°±3.9°，两组比较均有显著性差异（P＜0.01）。改良组术后出现轴性疼痛症状患者3例，传统组为19例，两组比较有显著性差异（P＜0.01）。随访期间两组均无再关门发生，两组均无钛板、螺钉松动移位。结论：与颈椎后路传统单开门椎管扩大成形术相比，改良单开门椎管扩大成形术在获得良好神经减压效果的同时，可减少手术费用，降低术后颈椎轴性症状的发生率，有利于颈椎曲度和颈椎活动度的维持。

英文摘要:

  【Abstract】 Objectives: To explore the clinical effects of modified cervical open-door laminoplasty for multiple-segment cervical spondylotic myelopathy. Methods: From June 2013 to December 2015, 60 patients with multiple-segment cervical spondylotic myelopathy undergoing posterior cervical single door laminoplasty were followed up. They were rdivided into two groups: 21 patients(17 males and 4 females) with the age of 66.2±10.0 years in modified laminoplasty group, and 39 patients(36 males and 3 females) with the age of 57.3±10.5 years in traditional laminoplasty group. The same mini titanium plates were used to fix the open-door lamina in all the patients. The operation time, intraoperative blood loss, postoperative hospital stay, surgery cost, follow-up results, preoperative and postoperative Japanese Orthopedic Association(JOA) scores, cervical curvature, cervical curvature index, neck motion range and axial symptoms were recorded and compared between the two groups. Results: There was no significant difference of gender, age, course of disease, operation time, intraoperative blood loss or postoperative hospital stay between the two groups(P>0.05). The average surgery cost of modified laminoplasty group was significantly lower than that of traditional laminoplasty group(P<0.05). Patients were followed up for 12-24 months. At 12 months after operation, all the patients in the two groups achieved bony fusion and significantly improved neurofunction. JOA score improved significantly in modified laminoplasty group, with the improvement rate of (60.46±9.65)%; while the improvement rate of traditional laminoplasty group was (46.41±24.33)%, there was no significant difference between the two groups(P>0.05). The loss of cervical curvature was 4.7°±1.9° in modified laminoplasty group and 8.9°±5.6° in traditional laminoplasty group, the difference was statistically significant between the two groups(P<0.05). The loss of cervical curvature index was (3.09±2.14)% in modified laminoplasty group and (6.27±3.42)% in traditional laminoplasty group, the difference was statistically significant between the two groups(P<0.05). The loss of neck motion range was 11.6°±7.8° in modified laminoplasty group and 13.0°±3.9° in traditional laminoplasty group, there was significant difference(P<0.01). Three cases in modified laminoplasty group and nineteen cases in traditional laminoplasty group presented with axial symptoms after operation, the difference was statistically significant(P<0.01). During the follow-up, all the patients in the two groups had no door closing or instrument failure. Conclusions: Modified cervical open-door laminoplasty is effective in nerve decompression when compared with traditional laminoplasty. Furthermore, it can decrease the incidence of postoperative cervical axial symptoms, relief axial pain and maintain the cervical curvature and neck motion range, also it reduces the surgery cost.