改良单开门椎管扩大成形术治疗脊髓型颈椎病

目的探讨改良单开门椎管扩大成形术治疗脊髓型颈椎病的疗效。方法2005年3月至2006年5月，18例脊髓型颈椎病患者接受改良单开门椎管扩大成形术，即受压节段两端行部分椎板切除，中央行单开门椎管扩大成形术（A组），23例患者接受传统C3-7，单开门椎板成形术，作为对照组（B组），对两组患者手术前后的JOA评分改善率、减压程度、颈椎曲度指数、颈椎活动度及轴性症状严重程度进行随访，并比较评估。结果41例全部获得随访，JOA评分恢复率A组为（62．0±26．4）％，B组为（62．7±19．8）％，两组差异无统计学意义；两组病例术后MRI均显示椎管减压充分．患者术后颈椎曲度指数丢失A组为（2．75±2．68）％，B组为（5．23±2．02）％，两组比较差异有统计学意义（P〈0．01）；术后颈椎活动度丢失A组为（7．21±4．07）°，B组为（13．16±6．34）。，两组差异有统计学意义（P〈0．01）；术后有明显轴性症状者A组为22．2％．B组为56．5％．两组比较差异有统计学意义（P〈0．05）。结论改良椎管扩大成形术获得了良好的神经减压效果，与传统C3-7单开门椎板成形术相比，在对颈椎曲度指数、颈椎活动度的影响以及轴性症状发生率等方面有明显改善。

Clinical Preliminary Report of Modified Open-door Laminoplasty

Objective To evaluate the clinical outcome of modified open door laminoplasty in treatment for cervical spondylotic myelopathy （CSM）. Methods Since March 2005 to May 2006, 41 cases of cervical spondylosis myelopathy（CSM） patients underwent extensive open-door laminoplasty. 18 patients who underwent modified opendoor laminoplasty which intermediary compressive laminae was undergone open-door laminoplasty and both-side laminae was undergone partial lamiuectomy were included in this study（group A）. 23 patients who underwent conventional C3-7 open-door laminoplasty in the authors department were served as control（group B）. Preoperative and postoperative improvement rate of Japanese Orthopedic Association （JOA） scores,the degree of axial symptom, the effect of decompression,ranges of neck motion,cervical curvature indices were recorded and compared. Results The average JOA improvement rate was （62. 0±26.4）% for group A and （62.7± 19.8）% for group B,There was no signifieant difference in JOA improvement rate between two groups. The rate of patients with evident axial symptoms was 22. 2% in group A and 56. 5% in group B and the difference was statistically significant（P〈0. 05）. Loss of cervical curvature indices was （2.75±2.68）% in group A and （5.23±2.02）% in group B,and the difference was statistically significant （P〈0.01）,Loss of ranges of neck motion was （7.21±4.07）° in group A and （13.16±6.34）° in group B, significant difference was also seen（P〈0.01 ）. Postoperative MRI of patient in group A indicated sufficient expansion of the spinal cord. Conclusion Modified open-door laminoplasty was less invasive to the posterior extensor mechanism and this new procedure is effective in preventing postoperative axial symptoms with adequate decompression of the spinal cord.