侧块螺钉固定术后不同颈椎曲度与脊髓后移的关系及其对手术疗效的影响

目的探讨全椎板减压侧块螺钉固定术后颈椎曲度大小与脊髓后移距离的关系及其对手术疗效的影响。方法回顾性分析2016年10月至2017年12月邯郸市中心医院行全椎板减压侧块螺钉固定术的85例脊髓型颈椎病患者的临床资料,其中有78例患者获得完整随访,术后根据Harrison方法测量颈椎曲度将患者分为A组(43例,0°≤颈椎角≤16.5°)和B组(35例,颈椎角>16.5°)。观察两组患者术后脊髓后移距离、神经恢复效果、轴性症状及C5神经麻痹发生情况。结果A组患者术后颈椎角为(8.5°±3.8°),B组为(19.6°±3.0°),两组比较差异有统计学意义(t=14.071,P<0.001);A组患者椎板切除宽度为(22.1±1.7)mm,B组为(21.8±1.5)mm,两组比较差异无统计学意义(P>0.05);A组患者脊髓后移距离为(1.7±0.4)mm,B组为(3.2±0.7)mm,两组比较差异有统计学意义(t=11.879,P<0.001)。术后两组患者神经功能均有显著恢复,至术后1年时,两组神经功能改善率分别为(63.3±13.1)%和(65.1±13.9)%,组间比较差异无统计学意义(t=0.587,P=0.559)。A组术后1周时VAS评分为(5.2±1.3)分,术后1个月时为(3.5±0.6)分;B组分别为(3.8±0.8)、(2.4±0.4)分,组间不同时间点比较差异均有统计学意义(t=5.567,P<0.001;t=9.289,P<0.001);A组患者C5神经麻痹发生率为7.0%(3/43),B组为11.4%(4/35),两组比较差异无统计学意义(P>0.05)。结论术后颈椎曲度越大脊髓后移越充分,术后颈椎曲度的丢失与轴性症状的发生有关,颈椎曲度与神经功能的恢复及C5神经麻痹的发生无关。

Relationship between different cervical curvature and spinal cord posterior movement after laminectomy with lateral mass screw fixation and its influence on the operative effect

Objective To investigate the relationship between cervical curvature(CC)and spinal drift distance after laminectomy with lateral mass screw fixation and the influence on the operative effect.Methods From October 2016 to December 2017,a total of 85 patients with cervical spondylotic myelopathy(CSM)underwent laminectomy with lateral mass screw fixation in handan central hospital,and 78 patients were followed up completely.After the operation,according to the Harrison method,they were divided into 2 groups(Group A(43 cases,0°≤CC≤16.5°);Group B(35 cases,CC>16.5°)).The spinal drift distance,nerve recovery,axial symptoms and C5 palsy in the groups were recorded and analyzed.Results The CC was 8.5°±3.8°in group A and 19.6°±3.0°in group B(t=14.071,P=0.000).The laminectomy width in group A was(22.1±1.7)mm,in group B was(21.8±1.5)mm,the difference between the two groups was not statistically significant(P>0.05).The distance of spinal cord backward movement was(1.7±0.4)mm in group A and(3.2±0.7)mm in group B.There was significant difference between the two groups(t=11.879,P<0.001).At the end of one year,the improvement rates of nerve function in the two groups were(63.3±13.1)%and(65.1±13.9)%respectively,there was no significant difference between the two groups(t=0.587,P=0.559).The VAS score of group A was(5.2±1.3)at one week and(3.5±0.6)at one month after operation,and that of group B was(3.8±0.8)and(2.4±0.4)respectively.There were statistically significant differences between groups at different time points(t=5.567,P<0.001;t=9.289,P<0.001).The incidence of C5 paralysis was 7.0%(3/43)in group A and 11.4%(4/35)in group B.There was no significant difference between the two groups(P>0.05).Conclusion The greater the curvature of cervical spine is,the more fully the spinal cord moves backward.The loss of curvature of cervical spine is related to the occurrence of axial symptoms.The curvature of cervical spine is not related to the recovery of nerve function and the occurrence of C5 nerve paralysis.