颈后路单开门椎管成形术门轴位置内移的疗效分析

目的探讨颈后路单开门椎管成形术门轴位置内移与术后临床疗效关系。方法将68例确诊为脊髓型颈椎病并行颈后路单开门椎管成形术的患者按治疗方法分为两组:1宽开门组:36例,为常规开门组,门轴位置为侧块内缘;2窄开门组:32例,为门轴内移组,门轴位于椎板外缘1/4处。比较两组患者手时间、术中出血量、术后神经功能恢复情况,以Ishihara法测定颈椎曲度指数、颈椎活动度及影像学的各项指标作统计学分析。结果手术时间、出血量、JOA评分改善率、颈椎曲度指数、颈椎活动度两组比较差异均无统计学意义(P0.05)。患者均获得随访,时间2年。两组患者术后均获得了满意的神经功能改善,但是轴性症状和C5神经根麻痹发生率窄开门组明显低于宽开门组(P0.01)。结论手术中适当将门轴位置内移既可以保证手术效果,又可以限制脊髓过度后移,有效避免C5神经根麻痹的发生,降低轴性症状的发生概率。

Effect analysis of shaft position within the shift of the posterior cervical single open-door ;laminoplasty

Objective To investigate the relationship of clinical effect and shaft position shift in the posterior cervical single open-door laminoplasty. Methods Sixty-eight patients with cervical spondylotic myelopathy parallel posterior cervical single open-door laminoplasty patients were divided into two groups according to treatment methods: ① the wide open group:36 cases, conventional open group, shaft was located in the medial margin of the lateral mass;②the narrow open group:32 cases for shaft displacement group. The door shaft was located in the outside margin 1/4. They were compared between two groups of patients in operative time, intraoperative bleeding volume, postoperative recovery of neurological function, with Ishihara determination of cervical curvature index, cervical motion and imaging indexes were statistically analyzed. Results The operation time, volume of bleeding, JOA score improvement rate, cervical vertebra protrusion index, cervical activity of the two groups were not statistically significant(P>0. 05). The patients were followed up for 2 years. Satisfactory neurological function was improved after surgery, but the incidence of axial symptom score and C5 nerve root palsy was significantly lower in the narrow open group than that of wide open door group (P<0. 01). Conclusions Surgery appropriate door shaft position shift can not only ensure the operation effect, and can limit the spinal cord over after the shift, effectively prevent the occurrence of C5 nerve root palsy and reduce axial symptom severity.