单开门椎板成形术联合椎间孔切开术治疗脊髓型合并神经根型颈椎病疗效分析

目的评价颈后路单开门椎管成形术联合椎间孔切开术在治疗颈椎管狭窄症合并单侧神经根型颈椎病中的作用。方法回顾性研究2006年7月至2009年1月44例颈椎管狭窄症合并单侧神经根压迫症状患者,行颈后路单开门椎管成形术联合椎间孔切开术治疗的23例患者为A组,单纯行颈后路单开门椎管成形术治疗的21例患者为B组。引起椎间孔狭窄的原因:椎间盘突出、钩椎关节骨赘形成、关节突增生。神经根症状主要表现为单侧上肢疼痛、感觉减退、肌力下降和反射减弱。A组手术为颈后路单开门椎管成形术联合椎间孔切开术,关节突内侧缘切除范围均小于等于50%;B组仅行颈后路单开门椎管成形术。结果术后随访20～36个月,平均28个月。采用日本骨科协会评分法计算两组髓性症状术后改善率,差异无统计学意义;根性症状术后临床效果评价:A组优18例,良3例,一般2例;B组优7例,良3例,一般9例,差2例。结论对合并有单侧神经根型的颈椎管狭窄症患者,采用颈后路单开门椎管成形术联合椎间孔切开术可取得良好的手术效果。

Efficacy of Expansion of Open-door Cervical Laminoplasty Combined Foraminotomy for Coexisting Cervical Stenosis and Unilateral Radiculopathy

Objective To evaluate the effect of expansion of open-door cervical laminoplasty combined foraminotomy for coexisting cervical stenosis and unilateral radiculopathy.Methods Retrospective study of July 2006 to January 2009,44 patients coexisting cervical stenosis and unilateral radiculopathy,A group:23 patients treated by expansion of open-door cervical laminoplasty combined foraminotomy;B group:21 patients treated by expansion of open-door cervical laminoplasty.The reasons of intervertebral foramen stenosis were:prolapse of intervertebral disc,osteophyte formation of Luschka joint,facet joint hypertrophy.The most significant nerve root symptoms were unilateral upper limb pain,reduced sensation,muscle weakness and diminished reflexes.A group treated by expansion of open-door cervical laminoplasty combined foraminotomy,Medial margin of the articular resection≤50%;B group treated by expansion of open-door cervical laminoplasty.Results Postoperative follow-up 20 to 36 months,an average of 28 months.There is no significant difference between the JOA improvement of the two group;Clinical evaluation of postoperative radicular symptoms:Group A excellent in 18 cases,good in 3 cases,fair in 2;Group B excellent in 7 cases,good in 3 cases,usually 9,and poor in 2 cases.Conclusion The operation results of expansion of open-door cervical laminoplasty combined foraminotomy for coexisting cervical stenosis and unilateral radiculopathy are effective.