C3扩大半椎板切除单开门椎板成形术治疗多节段颈脊髓压迫症

目的:探讨C_3扩大半椎板切除单开门椎板成形术治疗多节段颈脊髓压迫症的临床疗效。方法:对2014年9月至2018年5月收治的58例多节段颈脊髓压迫症患者进行回顾性研究,其中男34例,女24例;年龄46～78岁,平均64.4岁;28例采用C_3扩大半椎板切除C_4-C_7单开门椎板成形术(改良开门组),30例采用传统后路C_3-C_7单开门椎板成形术治疗(传统开门组)。比较两组患者的手术时间、术中出血、C_5神经麻痹及轴性症状(axial symptoms,AS)的发生情况;采用颈椎MRI横断面测量C_3节段最狭窄处(包括C_(3,4)椎间盘水平)脊髓有效空间(space available for the spinal cord,SAC),评价影像学指标改善情况。观察两组患者手术前后的日本骨科学会(Japanese Orthopaedic Association,JOA)评分、颈部功能障碍指数(Neck Disability Index,NDI),并计算神经功能改善率(RR)。结果:两组患者术后均获得随访,时间12～18个月,其中改良开门组平均随访时间为(14.5±1.8)个月,传统开门组为(14.5±1.9)个月,两组比较差异无统计学意义(P0.05)。两组患者在术中出血、C_5神经麻痹方面差异均无统计学意义(P0.05);但手术时间(119±10)minVS(126±12) min]、轴性症状发生率7.1%(2/28) vs 26.6%(8/30)],差异有统计学意义(P0.05)。改良开门组患者手术前后C_3水平脊髓有效空间分别为(93.61±9.02) mm~3和(153.5±12.76) mm~3,术后较术前明显扩大(P0.05);末次随访时改良开门组和传统开门组的JOA评分分别为14.36±1.70和14.03±1.82,NDI评分分别为10.36±2.55和12.47±3.46,两组差异有统计学意义(P0.05),但两组神经功能改善率(68.36±0.12)%VS(65.01±0.12)%]比较差异无统计学意义(P0.05)。结论:C_3扩大半椎板切除单开门椎板成形术不仅能够充分地解除脊髓压迫,而且通过减少C_2棘突肌肉止点的剥离,在预防轴性症状等并发症方面亦取得了良好的效果,是一种治疗多节段颈脊髓压迫症的有效方法。

Analysis of clinical efficacy of C3 expanded half lamina excision combined with unilateral open-door laminoplasty for multiple segmental cervical spinal cord compression syndrome

Objective: To explore the clinical efficacy of C₃ expanded half lamina excision combined with unilateral open-door laminoplasty for multiple segmental cervical spinal cord compression syndrome.Methods: The clinical data of 58 patients with multiple segmental cervical spinal cord compression syndrome underwent surgical treatment between September 2014 and May 2018 were retrospectively analyzed. There were 34 males and 24 females with a mean age of 64.4 years old (ranged from 46 to 78 years old). Among them,28 cases received the surgery of C₃ expanded half lamina excision combined with C₄-C₇ unilateral open-door laminoplasty (improved group),and 30 cases received a single C₃-C₇ unilateral open-door laminoplasty (traditional group). Operation time,intraoperative blood loss,complications including C₅ nerve root palsy and axial symptoms were compared between two groups. To evaluate the situation of the imaging indicators by measuring the space available for the spinal cord through cross-sectional MRI of cervical spine at the narrowest segment of C₃(including intervertebral disc levels of C_3,4). Pre-and post-operative Japanese Orthopedic Association(JOA) score,Neck Disability Index(NDI) score,and improvement rate of neurological function,were recorded and analyzed between the two groups.Results: All the patients were followed up for 12 to 18 months with an average of(14.5±1.8) months for improved group and (14.5±1.9) months for traditional group,and no significant difference was found between the two groups (P>0.05). There was no significant difference in intraoperative blood loss and C₅ nerve root palsy between the two groups (P>0.05). The operation time (119±10) min vs (126±12) min and axial symptoms 7.1%(2/28) vs 26.6%(8/30) was significant difference between the two groups(P<0.05). Preoperative and postoperative space available for the spinal cord of C₃ was (93.61±9.02) mm³ and (153.50±12.76) mm³ respectively,which was obtained obvious improvement in all patients(P<0.05). At the final follow-up,JOA scores of improved group and traditional group were 14.36±1.70 and 14.03±1.82 respectively,and NDI scores were 10.36±2.55 and 12.47±3.46 respectively,there was significant difference between two groups(P<0.05). However,there was no significant difference between two groups for the improvement rate (68.36±0.12)% VS (65.01±0.12)% of neurological function(P>0.05).Conclusion: C₃ expanded half lamina excision combined with unilateral open-door laminoplasty is an effective method to treat multiple segmental cervical spinal cord compression syndrome,for it can not only fully relieved spinal cord compression,but also achieved good effect in preventing complications such as axial symptoms by reducing stripping of muscles from C₂ spinous process.