颈椎单开门桥式植骨椎板成形术治疗脊髓型颈椎病

目的:探讨改良单开门桥式植骨椎板扩大成形术治疗脊髓型颈椎病的疗效及其相关影响因素。方法:采用改良单开门手术,C4、C6两处“桥式”植骨椎板扩大成形治疗61例脊髓型颈椎病患者。结果:随访2～8年,平均4.3年。JOA评分由术前的8.4±1.9分提高到随访时的12.4±3.0分(P<0.01)。其中优15例(24.6%),良16例(26.2%),可24例(39.4%),差6例(9.8%)。C3~C7曲度术后平均减少了8.7°(P<0.01)。CT测量骨性椎管面积术后平均增加67mm2(P<0.01)。矢状径术后平均增加4.1mm(P<0.01)。术后JOA评分改善率与术后骨性椎管面积的改善率两者的相关系数r=0.027。结论:改良单开门“桥式”植骨椎板成形术是一种安全和有效的术式;椎管骨性面积的增加是神经功能改善的基础,术后椎管矢状径扩大以4~5mm为宜。

Modified expansive laminoplasty for the treatment of cervical spondylotic myelopathy

Obj ective:To investigate the outcomes and the factors affecting the prognosis by mo dified single-door laminoplasty in the treatment of cervical spondylotic myelopa thy(CSM).Method:61patients with cervical CSM underwent modified single-door lam inoplasty by"bridge graft"in both C4and C6segment.The period of follow-up last ed from2to7years with a mean of4.3years.Neurologic deficits pre-and post-operati on were assessed using a scoring system proposed by the Japanese Orthopaedic Ass ociation(JOA score).Result:The JOA scores were improved from8.4points pre-oper ation to12.4points at the latest follow-up(P<0.01).Of these61patients,15patient s(24.6%)had excellent results,16(26.2%)good,24(39.4%)fair and6(9.8%)poor.The average curve of C3-C7was decreased from10.1degree pre-operatively to1.4degree post-operatively.Meanwhile,there was a significant enlargement of cross-sectiona l area of cervical canal by67mm 2 after surgery(P<0.01).The correlation coefficient R between improvement of J OA score and enlargement of cervical canal was0.027.Conclusion:Modified expansi ve single-door laminoplasty is a reliable procedure for CSM.Improve-ment of neu rologic function is based on enlargement of cervical canal,but there is no signi ficant line-correla-tion between JOA score improvement and cervical canal enlar gement statistically.