颈椎管狭窄椎板切除术疗效及并发症分析

目的探讨后路椎板减压治疗颈椎管狭窄症的疗效及术后并发症发生机制。方法经全椎板切除减压患者总计158例（减压范围均在3个节段以上），发生术后并发症而经再次前路手术或保守治疗者16例（A组）与未发生并发症者142例（B组），皆于手术前、后行脊髓功能JOA评分及体感神经诱发电位检查，随访时间2～5年。结果A组患者于首次后路减压3个月后其上肢的下运动神经元通路损害症状逐渐缓解，A组和B组患者间的脊髓JOA评分改善程度、体感神经诱发电位波幅和潜伏期变动率在术前及术后2年时间均无显著性差异，仅在术后3个月差异有显著性。结论后路手术后并发症系术中颈脊髓继发损伤致炎性反应加重，发生短暂脊髓组织可逆性再灌注损伤所致，经适当治疗可基本恢复；后路减压术后脊髓功能恢复与弓弦效应不呈正相关，而术后并发症发生却与其有一定关联。

The Analysis of Effect and Complication of the Stenosis of Cervical Spinal Canal Treated with Decompression Through Dorsal Laminectomy

Objective To investigate the efficiency of posterior decompression approach for cervical compressive myelopathy and etiology of postoperative complications. Methods 158 cases from Jan. 2001 to Oct. 2002 who underwent posterior laminectomy were enrolled for at least 2 years and compared with the evaluation systems of Japanese Orthopaedic Association Score and somatosensary evoked essential at different times. 21 patients （A group）after laminectomy who tolerated disturbance of postoperative complications were administrated by second operation or conservative treatment. Results Lesion of lower motor neurons and final common pathway of upper limb from A group were not relieved through above-mentioned treatment until 3 months after primary decompression. Concerning the recovery rate of JOA evaluation of spinal cord function and alternation radio of wave amplitude and latency,there was not significant difference between 137 sufferers （B group） without postoperative complications and A group at the preoperative period and 2 years after first operation,however,significant difference existed in 3 months after surgery. Conclusion ：a）We should not generalize most postoperative complications with palsy of cervical 5 spinal root,the essence of above-mentioned symptoms may be reversibly secondary injury（including temporary inflammatory reaction and reperfusion injury） due to decompression process,which would be alleviated by appropriate intervention;b）bowstring potency after posterior decompression hadnrt positive correlation to extent of functional recovery,however,certain relevant to possibility of postoperative complications.