保留C2和C7棘突肌肉止点的改良颈椎后路椎管扩大成型术的疗效分析

目的 了解保留C2和C7棘突肌肉止点的改良颈椎后路椎管扩大成型术在对颈椎前凸角度的影响,轴性症状的发生率等方面的临床效果,探讨保留颈后部肌肉止点在防止颈椎后路椎管扩大成型术术后并发症方面的作用.方法回顾性分析2001年1月至2009年1月28例采用保留C2和C7棘突肌肉止点的改良颈椎后路椎管扩大成型术和21例传统的颈椎后路椎管扩大成型术在术后和术后3个月随访时JOA改善率,颈椎Cobb角和Ishihara指数的变化,轴性症状的情况,手术时间和出血量方面的结果,并对结果进行统计学分析.结果 改良颈椎后路椎管扩大成型术和传统术式在术后JOA改善率方面的作用相同,Slac术式术后3个月随访时在颈椎Cobb角和Ishihara指数的变化上要小于传统术式,改良颈椎后路椎管扩大成型术在术后随访时患者出现轴性症状的比例和新出现症状的比例要低于传统术式,改良颈椎后路椎管扩大成型术的手术时间要少于传统术式.结论 颈椎后路手术中尽量避免对肌肉的损伤可以减少术后并发症的发生率.改良颈椎后路椎管扩大成型术可以更好的保护颈后部的伸肌组群,可以获得与传统术式相同的神经减压效果,可以更好的维持颈椎前凸角度,术后轴性症状的发生率较低.

Short-term clinical outcome of modified expansive open-door cervical laminoplasty preserving posterior extensor musculature inserted into C2 and C7 spinous process

Objective To assess the effect of modified cervical expansive open-door laminoplasty preserving the posterior extensor musculature inserted into the C2 and C7 spinous process upon maintaining the cervical lordotic alignment and axial syndrome and to determine whether preserving the posterior extensor musculature inserted into C2 and C7 spinous process can reduce the complications. Methods Twenty-eight patients undergoing modified cervical expansive open-door laminoplasty preserving the posterior extensor musculature inserted into the C2 and C7 spinous process and 21 patients undergoing conventional C3-C7 cervical expansive open-door laminoplasty were investigated in pre-operative,post-operative and 3-month follow-up. The investigators assessed the effects of two different cervical laminoplasty types in the recovery rate of JOA score,the changes of Cobb angle and Ishihara's index,axial syndrome,operating duration and intra-operative blood loss,analyzed the results in SPSS and tried to find the difference in two operative types. Results There were the same results in the recovery rate of JOA score and intra-operative blood loss in modified expansive open-door cervical laminoplasty group and the conventional C3-C7 cervical expansive open-door laminoplasty group. The smaller changes of Cobb angle and Ishihara's index in the follow-up of modified laminoplasty group were found. The modified laminoplasty group had fewer patients suffering the axial syndrome in fallow-up.The operating duration was shorter in the modified laminoplasty group.Conclusion Preventing muscle injuries in cervical laminoplasty can reduce the incidence of complications.The modified expansive open-door cervical laminoplasty preserving the posterior extensor musculature inserted into C2 and C7 spinous process can protect cervical posterior extensor musculature. This is helpful to maintain the cervical lordotic alignment and reduce the incidence of post-operative axial syndrome.