侧块开槽技术对颈椎后路单开门椎管扩大椎板成形术后骨性椎管横截面积的影响

Effects of guttering on the lateral mass technique in the cross-sectional area of spinal canal after unilateral open-door cervical laminoplasty

中文关键词:  颈椎  颈椎病  椎板成形术  侧块  侧块开槽技术

英文关键词:Cervical vertebrae  Cervical spondylosis  Laminoplasty  Lateral mass  Guttering on the lateral mass

中文摘要:

  【摘要】 目的：探讨侧块开槽技术在颈椎后路单开门椎管扩大椎板成形术扩大骨性椎管横截面积中的作用。方法：回顾性分析2021年2月～2024年2月采用颈椎后路单开门椎管扩大椎板成形术治疗的颈椎后纵韧带骨化症患者临床资料。其中37例患者采用了常规技术，纳入常规组；31例患者采用了侧块开槽技术，纳入侧块组。比较两组患者手术时间、术中出血量、术后引流量等指标及并发症发生情况。于术前、术后即刻、术后2个月及末次随访时采用疼痛视觉模拟量表（visual analogue scale，VAS）评估颈部疼痛程度；采用颈椎功能障碍指数（neck disability index，NDI）评估颈椎功能；采用日本骨科学会（Japanese Orthopaedic Association，JOA）评分评估神经功能状况；影像学测量包括颈椎侧位X线片上测量C2-7 Cobb角、C2-7矢状位偏移（sagittal vertical axis，SVA）及T1倾斜角（T1 slope），排除侧块开槽影响颈椎稳定性、颈椎曲度等可能；CT横断面上测量椎管面积，比较两组椎管面积增加的百分比。结果：患者均顺利完成手术，术后均未发生神经损伤、感染等并发症。两组患者的手术时间、住院时间、术中出血量、术后引流量的差异无统计学意义（P>0.05）。两组术后即刻、术后2个月及末次随访时的颈痛VAS评分、NDI及JOA评分较术前均有明显改善（P<0.05）；两组间术前、术后即刻、术后2个月及末次随访时的颈痛VAS评分及NDI均无统计学差异（P>0.05）；两组间术前JOA评分无统计学差异（P>0.05），术后即刻、术后2个月及末次随访时的JOA评分有统计学差异（P<0.05）。两组术后即刻、术后2个月及末次随访时的C2-7 Cobb角、C2-7 SVA及T1 slope均较术前无统计学差异（P>0.05）；两组间术前、术后即刻、术后2个月及末次随访时的C2-7 Cobb角、C2-7 SVA及T1 slope均无统计学差异（P>0.05）。两组术后即刻、术后2个月及末次随访时的平均椎管横截面积较术前均有明显改善（P<0.05）；两组间术前平均椎管横截面积无统计学差异（P>0.05），术后即刻、2个月及末次随访时侧块组的平均椎管横截面积优于常规组，差异有统计学意义（P<0.05）。结论：与常规的颈椎后路单开门椎管扩大椎板成形术相比，侧块开槽技术可明显扩大骨性椎管横截面积、改善术后神经功能的恢复。

英文摘要:

  【Abstract】 Objectives: To explore the effects of guttering on the lateral mass technique in enlarging the cross-sectional area of the spinal canal after unilateral open-door cervical laminoplasty. Methods: A retrospective analysis was conducted on the clinical data of patients with cervical ossification of posterior longitudinal ligament treated with unilateral open-door cervical laminoplasty between February 2021 and February 2024. 37 patients who underwent the conventional technique were included in the conventional group; 31 patients undergone guttering on the lateral mass technique were included in the lateral mass group. The operative time, intraoperative blood loss, postoperative drainage volume, and incidence of complications were compared between the two groups. At preoperation, immediately after surgery, 2 months after surgery, and the final follow-up, the neck pain was evaluated using the visual analog scale(VAS), the cervical function was assessed with the neck disability index(NDI), and the neurological function was appraised with the Japanese Orthopaedic Association(JOA) score. C2-7 Cobb angle, C2-7 sagittal vertical axis(SVA), and T1 slope were measured on the cervical lateral X-rays to eliminate the possibilities of guttering on the lateral mass affecting cervical stability and cervical curvature; The spinal canal area was measured on the CT cross-sectional image and the percentage increase in spinal canal area was compared between the two groups. Results: All the patients underwent the surgery successfully. No serious complications such as spinal cord injury or infection occurred. There were no significant differences in operation time, intraoperative blood loss, postoperative drainage volume between the two groups(P>0.05). The neck pain VAS scores, NDI and JOA scores in both groups showed significant improvement immediately after surgery, 2 months after surgery, and at final follow-up(P<0.05). There were no differences in neck pain VAS scores and NDI between the two groups at preoperation, immediately after surgery, 2 months after surgery and final follow-up(P>0.05). There was no statistical difference in preoperative JOA scores between the two groups(P>0.05), but there were statistically significant differences in JOA scores between the two groups immediately after surgery, 2 months after surgery, and at final follow-up(P<0.05). There were no statistical differences in C2-7 Cobb angle, C2-7 SVA, and T1 slope in both groups immediately after surgery, at 2 months after surgery, and at final follow-up, comparing with those before operation(P>0.05). No significant differences were found between the two groups in C2-7 Cobb angle, C2-7 SVA, and T1 slope at preoperation, immediately after surgery, at 2-month after surgery, and at the final follow-up(P>0.05). The average cross-sectional area of the spinal canal in both groups showed significant improvement immediately after surgery, at 2-month after surgery, and at final follow-up(P<0.05). There was no statistical difference in the preoperative average cross-sectional area of the spinal canal between the two groups(P>0.05). However, the average cross-sectional area of the spinal canal in the lateral mass group immediately after surgery, at 2-month after surgery, and at the final follow-up was larger than that in the conventional group, and the differences were statistically significant(P<0.05). Conclusions: Compared with the conventional unilateral open-door cervical laminoplasty, guttering on the lateral mass technique can significantly expand the cross-sectional area of the spinal canal and improve postoperative neurological function recovery.