保留颈半棘肌的颈椎后路双开门椎管扩大成形术的疗效研究

目的探讨保留颈半棘肌的颈椎后路双开门椎管扩大成形术的临床疗效.方法回顾性分析2001年2月至2009年7月行后路双开门颈椎椎管扩大成形术的189例患者的临床资料,根据术中是否切断C2棘突半棘肌将患者分为颈半棘肌切断组(C3~C7椎板成形术,102例)和颈半棘肌未切断组(C3椎板切除、C4~C7椎板成形术,87例).采用日本骨科协会(JOA)评分法进行神经功能评价;AS程度采用视觉模拟评分法(VAS)进行评价.结果两组手术时间、颈椎曲度、颈椎活动度、颈托固定时间比较,差异有统计学意义(P<0.05).两组术后6个月JOA评分均较术前有明显升高(P<0.05),但两组间比较,差异无统计学意义(P>0.05).术后轴性症状(AS)总发生率为30.2%(57/189),其中颈半棘肌切断组37例(19.6%)、颈半棘肌未切断组20例(10.6%),两组比较,差异有统计学意义(P<0.05).两组末次随访VAS均较术前明显下降(P<0.05);两组间比较,差异有统计学意义(P<0.05).结论颈椎后路双开门椎管扩大成形术可有效改善神经功能,但保留颈半棘肌的手术方式缩短了手术时间,保持了颈椎曲度和活动度,有助于减少术后AS的发生.

Study on the therapeutic effects of bilateral open-door posterior cervical expansive laminoplasty with the saving of cervical semispinalis

Objective To invstigate the clinical effects of the expansive bilateral opening-door posterior cervical expansive laminoplasty with the saving of cervical semispinalis.Methods The retrospective study involved 189 patients undergone bilateral open-door posterior cervical expansive laminoplasty from February 2001 to July 2009.The 189 patients were divided into cervial semispinalis cutting group（C3-C7 laminoplasty,102 cases） and cervial semispinalis saving group（C3 laminectomy,C4-C7 laminoplasty,87 cases）.The JapaneseOrthopaedic Association（JOA） scoring was applied to evaluate the nerve function.The visual analogue score（VAS） was applied to evaluate axial symptom（AS） degree.Results There had significant difference witn operat time,cervical curvature and range of motion,neck support fixation time between two groups（P 0.05）.Compared with the preoperation,the VAS decreased at the last follow-up（P 0.05）;and the difference between two groups had statistical significance（P 0.05）.Compared with the preoperation,the JOA scoring increased 6 months after operation in two groups（P 0.05）;but there had no statistical difference between two groups（P 0.05）.The occurring rate of AS was 30.2%（57/189）,including cervical semispinalis cutting group 37 cases（19.6%）,cervical semispinalis saving group 20 cases（10.6%）,the difference between two groups had statistical significance（P 0.05）.Conclusion The bilateral open-door posterior cervical expansive laminoplasty can improve nerve function,and the postoperative AS of patients can be reduced if retaining cervical semispinalis by shortening operative time,keeping cervical curvature and maintaining range of motion.