内窥镜下微创颈椎管扩大成形术治疗多节段脊髓型颈椎病的中长期疗效

The mid-long-term effect of minnimally invasive expansive laminoplasty for cervical spondylotic myelopathy using microendoscopy

中文关键词:  颈椎病  椎管扩大成形术  微创  中长期  效果

英文关键词:Cervical spondylosis  Laminoplasty  Minimally invasive  Mid-long-term  Effect

中文摘要:

  【摘要】 目的：评价内窥镜下微创颈椎管扩大成形术（cervical microendoscopic laminoplasty，CMEL）治疗多节段脊髓型颈椎病的中长期治疗效果。方法：2010年1月～2013年1月我院采用CMEL治疗多节段脊髓型颈椎病患者19例，其中男12例，女7例，年龄56.0±10.5岁（38~72岁），病程15.0±6.3个月。其中三节段者3例，四节段者6例，五节段者10例，共166个椎板行双侧开槽微型钛板固定。比较患者术前和术后1周、3个月、1年、2年及末次随访时的JOA评分、手术节段椎管/椎体矢状径比值、颈椎活动度及颈椎曲度（C2～C7 Cobb角）。结果：19例手术时间为49～133min（114.0±19.9min），术中出血量100～375ml（219.0±70.5ml）。1例术中发生硬脊膜破裂，术后出现低颅压头痛，给予补液及止痛治疗5d后头痛逐渐缓解。19例患者均获得随访，随访5～8年，平均7.00±0.76年。术后1周、3个月、1年、2年及末次随访时的JOA评分与术前比较均明显增加（P＜0.05），末次随访时JOA评分改善率为（70.0±6.9）%。术后1周、3个月、1年、2年及末次随访时的手术节段椎管/椎体矢状径比值与术前比较均明显增大（P＜0.05），颈椎活动度、C2～C7 Cobb角与术前比较均无显著性差异（P＞0.05）。在行双侧开槽微型钛板固定的166个椎板中，术后3个月发生骨性愈合有112个，愈合率为67.5%；术后1年发生骨性愈合有122个，愈合率为73.5%；末次随访时发生骨性愈合有128个，愈合率为77.1%。末次随访时微型钛板及螺钉位置良好，无钛板、螺钉断裂及螺钉松动。结论：CMEL治疗多节段脊髓型颈椎病具有较好的中长期治疗效果，是一种安全、可靠的手术方式。

英文摘要:

  【Abstract】 Objectives: To evaluate the mid-long-term effect of minimally invasive expansive laminoplasty for cervical spondylotic myelopathy by using microendoscopy. Methods: From January 2010 to January 2013, 19 patients with cervical spondylotic myelopathy treated by cervical microendoscopic laminoplasty(CMEL) in our hospital were reviewed in this study. There were 12 males and 7 females with a mean age of 56 years (range, 38-72 years). The mean course of disease was 15 months(range, 8.7-21.3 months). Among these patients, 3 segments, 4 segments and 5 segments laminoplasty were performed in 3, 6 and 10 cases respectively. A total of 166 vertebral laminae was bilaterally slotted and fixed. The JOA score, the sagittal diameter of spinal canal/body rate of surgical segment, the range of motion(ROM) of cervical spine and the alignment of cervical spine were analyzed at preoperation, 1 week after surgery, 3 months after surgery, 1 year after surgery, 2 years after surgery and the final follow-up respectively. Results: The mean operation time was 114.0±19.9min(range, 49-133min). The mean blood loss was 219.0±70.5ml(range 100-375ml). Dural rupture occurred in 1 case during operation and then it appeared hypotensive cranial pressure headache after operation, headache gradually eased after which was given rehydration and analgesic treatment for 5 days. All of the 19 patients achieved average 7.00±0.76 years followed-up(range, 5-8 years). The mean JOA scores at 1 week after surgery, 3 months after surgery, 1 year after surgery, 2 years after surgery and the final follow-up were significantly increased compared to the preoperative ones(P＜0.05), and the improvement rate at the final follow-up was (70.0±6.9)%. The mean surgical segment sagittal diameter of spinal canal/body rate at 1 week after surgery, 3 months after surgery, 1 year after surgery, 2 years after surgery and the final follow-up were significantly increased compared to the preoperative ones(P＜0.05). The mean cervical vertebra activity at 1 week after surgery, 3 months after surgery, 1 year after surgery, 2 years after surgery and the final follow-up showed no significant difference compared to the preoperative ones(P＞0.05). The mean C2-C7 Cobb angle at neutral position at 1 week after surgery, 3 months after surgery, 1 year after surgery, 2 years after surgery and the final follow-up showed no significant difference compared to the preoperative ones(P＞0.05). A total of 166 vertebral laminae was bilaterally slotted and fixed. At 3 months after surgery, 112 laminae were observed bone healing and the bone healing rate was 67.5%. At 1 year after surgery, 122 laminae were observed bone healing and the bone healing rate was 73.5%. 128 laminae were observed bone healing at the final follow-up and the bone healing rate was 77.1%. The micro-titanium plate and screw were fixed in good position, no titanium plate, screw fracture and screw loosening were found at the final follow-up. Conclusions: CMEL is a safe and reliable surgical method, which has a good mid-long-term therapeutic effect on cervical spondylotic myelopathy.