颈后路单侧显露完全保留对侧椎旁肌的椎管扩大成形术治疗多节段退变性颈椎疾病的疗效观察

Unilateral exposure and contralateral-paravertebral-muscle-preserving laminoplasty in the treatment of multilevel degenerative cervical spondylosis

中文关键词:  颈椎病  颈椎后路手术  单侧显露  椎管扩大术

英文关键词:Cervical spondylosis  Posterior cervical approach  Unilateral exposure  Laminoplasty

中文摘要:

  【摘要】 目的：观察颈后路单侧显露完全保留对侧椎旁肌的椎管扩大成形术治疗多节段退变性颈椎疾病的临床疗效。方法：回顾性分析我院2019年3月~2020年12月通过单开门椎管扩大成形术治疗的76例多节段退变性颈椎疾病患者，男性41例，女性35例，年龄61.4±8.2岁。其中31例采用单侧显露完全保留一侧椎旁肌的颈椎管扩大成形术，纳入肌肉保留（muscle-preserved，MP）组；45例采用常规单开门椎管扩大成形术，纳入常规（open-door laminoplasty，LP）组，随访16.3±5.2个月。比较两组患者的年龄、性别及体重指数（body mass index，BMI），记录并比较手术时间、出血量、术后引流量，收集并比较两组患者术前、术后即刻、术后2个月、术后1年及末次随访时颈肩部及上肢视觉疼痛模拟评分（visual analog scale，VAS）、颈椎残障指数（neck disability index，NDI）及日本骨科协会（Japanese Orthopaedic Association，JOA）评分。患者术前、术后即刻、术后2个月、术后1年及末次随访时的颈椎侧位X线片上测量C2-C7 Cobb角，CT横断面上测量椎管面积，比较两组椎管面积的增加百分比。结果：所有患者均顺利完成手术。MP组手术时间为75.4±19.3min，出血量为97.8±36.2ml，术后引流量为134.2±40.3ml；LP组手术时间为88.3±21.2min，出血量为182.5±47.8ml，术后引流量为225.8±49.0ml。MP组手术时间、出血量、术后引流量均低于LP组（P<0.05）。两组患者术后各时间点NDI及JOA评分均较术前有明显改善（P<0.05），两组间术前及随访期间各时间点NDI及JOA评分的无统计学差异（P>0.05）。术后即刻及术后2个月时MP组的颈痛VAS评分低于LP组（P<0.05），但在1年时无显著差异（P>0.05）。MP组和LP组术后早期轴性颈痛发生率分别是19.7%和28.5%，有统计学差异（P<0.05）；MP组和LP组术后1年轴性颈痛发生率13.2%和14.6%，无统计学差异（P>0.05）。MP组术后即刻C2-C7 Cobb角为9.8°±8.4°，末次随访为8.1°±7.9°；LP组术后即刻C2-C7 Cobb角为9.5°±8.4°，末次随访为4.0°±7.7°。两组间术前及术后即刻C2-C7 Cobb角无统计学差异（P>0.05），两组术后各时间点C2-C7 Cobb角有统计学差异（P<0.05）。MP组术后即刻平均椎管面积较术前增加（109.6±18.4）%，末次随访较术前增加（105.2±19.8）%；LP组术后即刻平均椎管面积较术前增加（115.2±19.0）%，末次随访较术前增加（111.4±20.9）%，两组椎管面积增加无统计学差异（P>0.05）。结论：单侧显露完全保留对侧椎旁肌的椎管扩大成形术可减少手术时间、手术出血及术后引流量，降低术后早期轴性颈痛的发生率。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical effect of unilateral exposure and contralateral-paravertebral-muscle-preserving laminoplasty in the treatment of multilevel cervical spondylosis. Method: Data of 76 patients diagnosed with multilevel degenerative cervical spondylosis who underwent open-door laminoplasty from March 2019 to December 2020 were reviewed retrospectively. There were 41 male patients and 35 female patients, with an average age of 61.4±8.2 years. The average postoperative follow-up was 16.3±5.2 months. Among them, 31 patients who underwent unilateral exposure and contralateral-paravertebral-muscle-preserving laminoplasty were defined as muscle-preserved group(MP), and 45 patients who underwent traditional open-door laminoplasty were enrolled and defined as traditional open-door laminoplasty group(LP). Patient characteristics such as age, sex and body mass index(BMI) were compared. Surgical parameters like the operative time, blood loss, amount of post-operative drainage were compared. The visual analog scale(VAS), neck disability index(NDI) and Japanese Orthopaedic Association(JOA) scores of the two groups were compared before operation, immediately after operation, 2 months after operation, 1 year after operation and at the last follow-up. The C2-C7 Cobb angle was measured on the lateral cervical spine X-ray film before and after operation and during clinical follow-up. The cross-sectional area of spinal canal was measured on CT cross section. Increased cross-sectional area of spinal canal was compared between the two groups. Results： All patients underwent operations successfully. In MP group and LP group, the average operative time was 75.4±19.3min and 88.3±21.2min, the mean blood loss was 97.8±36.2ml and 182.5±47.8ml, and the mean postoperative drainage was 134.2±40.3ml and 225.8±49.0ml, respectively. The operative time, blood loss, and postoperative drainage in MP group were significantly less than those in LP group(P<0.05). The postoperative scores of NDI and JOA in the two groups were significantly improved compared with those before operation(P<0.05), there was no significant difference in NDI and JOA scores between the two groups before operation and during follow-up(P>0.05). The neck pain VAS scores of MP group were lower than those of LP group immediately after operation and at 2 months after operation(P<0.05), but there was no significant difference between the two groups at 1 year follow-up(P>0.05). At 2 months after operation, the incidence of early postoperative axial neck pain in MP group and LP group were 19.7% and 28.5% respectively, and there was significant difference between the two groups(P<0.05). At 1 year after operation, the incidence of axial neck pain in two group were 13.2% and 14.6% respectively, and there was no significant difference between the two groups(P>0.05). The C2-C7 Cobb angles immediately after operation and at the last follow-up were 9.8°±8.4° and 8.1°±7.9° in MP group, which were 9.5°±8.4° and 4.0°±7.7° in LP group, respectively. There was no significant difference in the C2-C7 Cobb angle between the two groups before and immediately after operation(P>0.05). There were significant differences in the C2-C7 Cobb angle between the two groups during postoperative follow-ups(P<0.05). In MP group, the area of spinal canal increased by(109.6±18.4)% immediately after operation and (105.2±19.8)% at the final follow-up comparing with that before operation. In LP group, comparing with before operation, the area of spinal canal increased by (115.2±19.0)% immediately after operation and (111.4±20.9)% at the last follow-up. At each follow-up time point, the increase of average spinal canal area in LP group was slightly larger than that in MP group, but there was no significant difference between the two groups(P>0.05). Conclusions： Unilateral exposure and contralateral-paravertebral-muscle-preserving laminoplasty can reduce the operation time, bleeding, and postoperative drainage. It also can reduce the incidence of early postoperative axial neck pain.