颈椎后路双开门椎管扩大成形术中不同开门角度对脊髓型颈椎病患者短期疗效的影响

The influence of different lamina opening angles in posterior cervical double door laminoplasty on the short-term efficacy of patients with cervical spondylotic myelopathy

中文关键词:  脊髓型颈椎病  颈后路双开门椎管扩大成形术  椎板开门角度  短期疗效

英文关键词:Cervical spondylotic myelopathy  Posterior cervical double-door laminoplasty  Laminar opening angle  Short-term efficacy

中文摘要:

  【摘要】 目的：探讨颈椎后路双开门椎管扩大成形术中不同椎板开门角度对脊髓型颈椎病（cervical spondylotic myelopathy，CSM）患者术后短期疗效的影响。方法：回顾性分析2019年1月~2023年12月行颈椎后路双开门椎管扩大成形术的CSM患者35例（男18例，女17例，年龄61.49±11.27岁）。手术方式均为C4~C6双开门椎管扩大成形+C3下1/2或全椎板+C7上1/2椎板切除减压术，随访时间12.7±1.12个月。术后1周复查颈椎CT，按椎板开门角度<60°、60°~68°、>68°将患者分为3组：A组（52.05°~58.53°）13例患者，男性6例，女性7例；B组（60°~68°）13例患者，男性7例，女性6例；C组（68.52°~71.3°）9例患者，男性5例，女性4例。三组患者年龄、病程无统计学差异（P>0.05）。于术后1周、术后1个月、3个月、6个月、12个月时采用日本骨科协会（Japanese Orthopaedic Association，JOA）评分、颈部疼痛视觉模拟量表（visual analogue scale，VAS）评分及神经功能改善率（recovery rate，RR）评估疗效，数据经SPSS 26.0软件进行统计学分析。结果：术前与术后12个月时A组JOA评分分别为9.81±1.03分和15.92±0.64分，B组为9.85±1.03分和15.46±1.11分，C组为9.67±1.17分和15.56±0.81分，各组术后12个月时JOA评分均显著高于术前，差异有统计学意义（P<0.05）。术后不同随访时间各组组间比较JOA评分无明显统计学差异（P>0.05）。A、B、C三组不同时间点组间比较VAS评分差异无统计学意义（P>0.05）；术后3个月、6个月、12个月A、B、C三组的VAS评分均较术前显著性降低（P<0.05）。A、B、C三组术后12个月神经功能改善率（RR）分别为（74.79±6.78）%、（69.25±12.26）%、（70.92±8.44）%。结论：颈后路双开门椎管扩大成形术治疗CSM，术后椎板开门角度于52.05°~71.3°范围内变化对患者短期疗效无显著影响。

英文摘要:

  【Abstract】 Objectives: To investigate the short-term clinical outcomes of different lamina opening angles during cervical laminoplasty with a double-door technique for patients with cervical spondylotic myelopathy(CSM). Methods: A retrospective analysis was conducted on 35 patients(18 males, 17 females, aged 61.49±11.27 years) with CSM who underwent cervical double-door laminoplasty between January 2019 and December 2023. All patients received C4-C6 double-door laminoplasty with partial or total laminectomy of C3 and partial laminectomy of C7. The follow-up period was 12.7±1.12 months. One week after operation, cervical CT was reexamined. The lamina opening angles were classified as <60°, 60°-68°, and >68°. Based on this, the patients were divided into 3 groups: group A(52.05°-58.53°), 13 patients, including 6 males and 7 females; Group B(60°-68°), 13 patients, including 7 males and 6 females; Group C(68.52°- 71.3°), 9 patients, including 5 males and 4 females. Clinical outcomes were assessed using the Japanese Orthopaedic Association(JOA) score, the visual analog scale(VAS) score for neck pain, and the recovery rate(RR) at 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively. Statistical analysis was performed using SPSS software version 26.0. Results: The JOA scores were 9.81±1.03 and 15.92±0.64 in group A, 9.85±1.03 and 15.46±1.11 in group B, and 9.67±1.17 and 15.56±0.81 in group C, respectively at preoperaion and 12 months after opreation, showing statistically significant improvements within each group(P<0.05). However, no significant differences in JOA scores were observed between groups at any postoperative time point(P>0.05). VAS scores at various follow-up time points showed no significant differences between groups(P>0.05). Within-group pairwise comparisons showed that the VAS scores at 3, 6, and 12 months postoperatively were significantly lower than the preoperative values(P<0.05). The RRs at 12 months after operation were (74.79±6.78)% in group A, (69.25±12.26)% in group B, and （70.92±8.44）% in group C. Conclusions: In posterior cervical double-door laminoplasty for CSM, postoperative laminar opening angles ranging from 52.05° to 71.3° have no significant impact on short-term clinical outcomes.