两种颈后路单开门手术方法对颈椎曲度指数及活动度的影响

目的]探讨两种颈后路单开门手术方法对术后患者神经功能改善率、颈椎曲度指数、颈椎活动度的影响及其临床意义.方法]自2008年6月～2011年9月,78例脊髓型颈椎病患者接受颈后路单开门椎管扩大成形术.A组41例患者行改良术式,即保留颈半棘肌肌止,切除C3椎板,C4-7“锚定法”单开门椎管扩大成形术.B组37例患者行传统C3-7单开门椎管成形术.计算两组患者神经功能改善率及术前术后颈椎曲度指数、颈椎活动度的变化,研究两组间差异.结果]两组患者术后神经功能改善恢复率,A组为(57.5±19.4)％,B组为56.3±19.8％,两组间差异无统计学意义,术后颈椎曲度指数丢失百分比,A组丢失(2.86±2.44)％,B组丢失(5.31±2.12)％,B患者手术前后颈椎曲度指数丢失明显多于A组.术后颈椎活动度,A组患者术后丢失(8.27±5.03).,B组患者术后丢失(11.06±6.97)°,两组差异有统计学意义(P＜0.01).结论]保留颈半棘肌肌止,C3椎板切除,C4-7“锚定法”单开门椎管扩大椎管成形术,与传统术式相比具有同样的神经功能改善率,同时能有效防止颈椎曲度指数及颈椎活动度的丢失.

Clinical effect of two posterior single open-door laminoplasty on cervical curvature index and ranges of neck motion

Objective]To discuss clinical effect of two posterior single open-door laminoplasty on cervical curvature index and movement of the cervical spine.Methods]Since June 2008 to September 2011,41 patients underwent extensive open-door laminoplasty,as reserved insertion of musculus semispinalis cervicis with C3 laminectomy and C4~7 modified open-door laminoplasty using "anchoring metlaod"(Group A),37 patients underwent conventional C3~7 open-door laminoplasty(Group B).Preoperative and postoperative improvement rate of Japanese Orthopedic Association(JOA) scores,ranges of neck motion,cervical curvature indices were recorded and compared.Results]The average of JOA improvement rate were(57.5±19.4)% for group A,and(56.3±19.8)% for group B.There was no significant difference in JOA improvement rate between two groups.Loss of cervical curvature indices were(2.86±2.44)% in group A and(5.31±2.12)% in group B,and the difference was statistically significant(P<0.01).Loss of ranges of neck motion were(8.27± 5.03)° in group A and(11.06±6.97)° in group B,significant difference was also seen(P<0.01).Conclusion]Compared with the conventional operation,C3 laminectomy and C4~7 modified open-door laminoplasty using "anchoring method" is effective in preventing the loss of cervical curvature index and movement of the cervical spine,with adequate decompression of the spinal cord.