颈后路经肌间隙入路“升顶式”椎管扩大椎板成形术后早期颈椎矢状面平衡的变化

The preliminary changes of sagittal balance of cervical spine after posterior cervical intermuscular raising roof laminoplasty

中文关键词:  脊髓型颈椎病  颈后路椎管扩大椎板成形术  经肌间隙入路  升顶  矢状面平衡  颈椎活动度

英文关键词:Cervical spondylotic myelopathy  Posterior cervical laminoplasty  Intermuscular approach  Raising roof  Sagittal balance of cervical spine  Cervical range of motion

中文摘要:

  【摘要】 目的：探讨颈后路经肌间隙入路“升顶式”椎管扩大椎板成形术治疗多节段脊髓型颈椎病（cervical spondylotic myelopathy，CSM）的早期临床疗效。方法：回顾性分析2013年8月~2020年9月我院采用颈后路椎管扩大椎板成形术治疗的75例多节段CSM患者，其中42例患者采用颈后路经肌间隙入路“升顶式”椎管扩大椎板成形术（升顶组），年龄31~79岁（57.2±10.7岁）；33例患者采用传统“关节囊悬吊法”单开门椎管扩大椎板成形术（悬吊法组），年龄48~82岁（67.2±9.6岁）。所有患者于术后3～14个月门诊随访。收集两组患者的住院相关基本信息；在术前和末次随访时的颈椎X线片上测量颈椎矢状面平衡参数，包括C0-2 Cobb角、C2-7 Cobb角、C2-7矢状面轴向距离（C2-7 SVA）、C7倾斜角（C7-Slope），同时测量颈椎活动度（ROM）；术前和末次随访时采用改良JOA（mJOA）评分、VAS评分和颈椎功能障碍指数（NDI）评估，计算mJOA评分改善率。结果：两组患者性别、术中出血量和平均随访时间差异无统计学意义（P>0.05）。升顶组患者年龄和术后住院天数均小于悬吊法组（P<0.05）。两组术前C0-2 Cobb角、C2-7 Cobb角、C2-7 SVA、C7-Slope和颈椎ROM均无统计学差异（P>0.05），末次随访时升顶组C7-Slope和C2-C7 SVA小于悬吊法组（P<0.05），C2-7 ROM大于悬吊法组（P<0.05）。两组末次随访时mJOA和VAS评分与术前比较均有明显改善，差异有统计学意义（P<0.05）；两组间同时间点mJOA和VAS评分比较无统计学差异（P>0.05），mJOA评分改善率亦无统计学差异（P>0.05）。两组末次随访时NDI与术前比较无统计学差异（P>0.05），两组间同时间点比较亦无统计学差异（P>0.05）。结论：与传统颈后路单开门椎管扩大椎板成形术相比，颈后路经肌间隙入路“升顶式”椎管扩大椎板成形术治疗多节段CSM早期可获得相同神经功能改善效果，且在维持颈椎矢状面平衡及颈椎活动度方面更具优势。

英文摘要:

  【Abstract】 Objectives: To explore the preliminary clinical effects of multilevel cervical spondylotic myelopathy(CSM) by posterior cervical intermuscular raising roof laminoplasty. Methods: 75 patients with multilevel cervical spondylotic myelopathy underwent posterior cervical laminoplasty at our hospital between August 2013 and September 2020 were recruited in this retrospective study. Of all patients, 42 treated with posterior cervical intermuscular "raising roof" laminoplasty were included in the raising roof group(mean age, 57.2±10.7 years; ranged 31 to 79 years), and 33 underwent posterior single open-door laminoplasty by traditional suture suspension fixation were included in the suture suspension group(mean age, 67.2±9.6 years; range 48 to 82 years). All patients were followed up at 3-14 months after surgery at the outpatient department. The basic hospitalization information of the patients in the two groups were collected; Cervical sagittal balance parameters, including C0-2 Cobb angle, C2-7 Cobb angle, C2-7 sagittal vertical axis(C2-7 SVA), C7-Slope, and cervical range of motion (ROM) were measured on X-ray images before the operation and at the last follow-up. The modified JOA(mJOA) score, visual analogue scale(VAS) score and neck disability index(NDI) were evaluated before the operation and at the last follow-up, and the mJOA score recovery rate was calculated. Results: There were no significant differences in terms of gender, intraoperative blood loss, and the mean follow-up time between the two groups(P>0.05). The age and postoperative hospital stay of patients in the raising roof group were smaller than those of the suture suspension group(P<0.05). There were no significant differences in preoperative C0-2 Cobb angle, C2-7 Cobb angle, C2-7 SVA, C7-Slope and cervical ROM(P>0.05). C7-Slope and C2-C7 SVA of the raising roof group were smaller than those in suture suspension group at the last follow-up(P<0.05), while C2-7 ROM in the raising roof group was better at the last follow-up(P<0.05). The mJOA and VAS scores of both groups at the last follow-up were significantly improved than those before operation, and the differences were of statistical significance. There was no significant difference in mJOA and VAS scores between the two groups at the same time point(P>0.05), nor was there significant difference in mJOA score improvement rate(P>0.05). The NDI of both groups at the last follow up were not improved significantly than those before operation(P>0.05), also there was no statistical significance between the two groups at the same time point(P>0.05). Conclusions: Posterior cervical intermuscular raising roof laminoplasty can achieve the same neurological function improvement as the traditional posterior cervical single open-door laminoplasty in the early stage after operation in the treatment of multilevel CSM, and besides, it has more advantages in maintaining sagittal balance and cervical range of motion.