目的系统评价保留C_(7)棘突肌肉韧带复合体改良椎管扩大成形与传统椎管扩大成形手术治疗多节段颈椎病的临床疗效。方法计算机检索PubMed、Cochrane Central、EMbase、the ISI Web of Knowledge Database、知网、维普、万方数据库。检索时间为建库时间至2020年12月1日。纳入关于保留C_(7)棘突改良椎管扩大成形与传统椎管扩大成形两种手术方法治疗脊髓型颈椎病疗效比较的随机对照试验、前瞻性或回顾性研究。利用Rev-Man 5.3软件进行Meta分析。结果共有10篇研究符合纳入标准,共603例患者,改良组268例,传统组335例。Meta分析结果显示:改良组术后轴性症状发生率、VAS评分低于传统手术组(P<0.05),术后JOA评分改善率两者差异无统计学意义(P>0.05)。结论保留C_(7)棘突改良椎管扩大成形术与传统椎管扩大成形术治疗脊髓型颈椎病均的疗效相当,均可有效改善各项评分,前者可以有效降低术后轴性症状的发生率。 相似文献
Background:Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy (CSM).Each posterior technique has its own advantages and disadvantages.In the presen... 相似文献
Retrospective study on the results of microendoscopic decompression surgery for the treatment of cervical myelopathy. The
purpose of this study was to describe the microendoscopic laminoplasty (MEL) technique as the surgical method in the treatment
of cervical myelopathy, and to document the clinical outcomes for MEL surgery. Endoscopic surgery poses several challenges
for the aspiring endoscopic surgeons, the most critical of which is mastering hand–eye coordination. With training in live
animal and cadaver surgery, the technical progress has reduced the problem of morbidity following surgery. The authors have
performed microendoscopic decompression surgery on more than 2,000 patients for lumbar spinal canal stenosis. Fifty-one patients
underwent the posterior decompression surgery using microendoscopy for cervical myelopathy at authors’ institute. The average
age was 62.9 years. The criteria for exclusion were cervical myelopathy with tumor, trauma, severe ossification of posterior
longitudinal ligament, rheumatoid arthritis, pyogenic spondylitises, destructive spondylo-arthropathies, and other combined
spinal lesions. The items evaluated were neurological evaluation, recovery rates; these were calculated following examination
using the Hirabayashi’s method with the criteria proposed by the Japanese Orthopaedic Association scoring system (JOA score).
The mean follow-up period was 20.3 months. The average of JOA score was 10.1 points at the initial examination and 13.6 points
at the final follow-up. The average recovery rate was 52.5%. The recovery rate according to surgical levels was, respectively,
56.5% in one level, 46.3% in two levels and 54.1% in more than three levels. The complications were as follows: one patient
sustained a pin-hole-like dura mater injury inflicted by a high-speed air-drill during surgery, one patient developed an epidural
hematoma 3 days after surgery, and two patients had the C5 nerve root palsy after surgery. The epidural hematoma was removed
by the microendoscopy. All two C5 palsy improved with conservative therapy, such as a neck collar. These four patients on
complications have returned to work at the final follow-up. This observation suggests that the clinical outcomes of microendoscopic
surgery for cervical myelopathy were excellent or showed good results. This minimally invasive technique would be helpful
in choosing a surgical method for cervical myelopathy. 相似文献
Purpose The aim of the study was to evaluate patients with multisegmental cervical spondylotic myelopathy (MCM) surgically treated
via a dorsal approach. Two different laminoplasty techniques were compared by assessment of enlargement of the spinal canal
and the neurological outcome.
Methods Thirteen patients (mean age 49 years, 11 males) underwent decompressive laminoplasty over a 7-year period. The average duration
of symptoms was 21 months. The pre- and postoperative degree of myelopathy was assessed by both the Nurick grading and the
Japanese Orthopaedic Association myelopathy score (JOA score). Preoperatively, the mean Nurick grade was 3.1 and the mean
JOA score was 11. Two different techniques of expansive laminoplasty were used. Six patients underwent a bilateral cutting
(BL) technique with retropositioning of the laminae and bilateral mini-plating (BL group). Seven patients were operated on
by simple open-door (OD) laminoplasty with unilateral mini-plating (OD group). Postoperatively, CT scans were obtained for
all patients to measure the sagittal diameter of the spinal canal. The mean clinical and radiological follow-up was 33 months.
Results Four to five laminae were involved in all patients.The mean operation time was 180 min. Complications occurred in two patients
of BL group, with immediate postoperative neurological deterioration due to ventral displacement of the laminae. Overall,
the average sagittal diameter (SD) of the spinal canal increased from 9.2 ± 1.3 mm to 12.4 ± 1.3 mm after surgery. The average
enlargement of SD was significantly higher for the OD group (p < 0.0075 ). In total, the improvement rate was 38% according to the Nurick grading and 69% according to the JOA score. For
the OD group, improvement rates were 57% (Nurick) and 71% (JOA).
Conclusions Decompressive laminoplasty is comparable with anterior surgery in neurological outcome. The OD technique seems to be superior
to our BL technique regarding both the enlargement of SD and complication rate. 相似文献
Wang MY, Shah S, Green BA. Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy.
Background
Laminoplasty is a well-recognized technique for decompressing the cervical spine in cases of spondylotic myelopathy and ossification of the posterior longitudinal ligament. This technique, originally popularized in Asia, is becoming more widespread, but to date there have been few reports of clinical series from North American centers.
Methods
Retrospectively we reviewed (1986-2001) 204 cases of open door laminoplasty. All patients presented with symptoms and magnetic resonance imaging (MRI) findings consistent with myelopathy secondary to multisegmental cervical stenosis with spondylosis and underwent decompression from C3 to C7. Improvement in myelopathy was assessed with the Nurick Score.
Results
Average age was 63 years (range 36 to 92). Follow-up averaged 16 months. Postoperatively, Nurick scores improved by 1 point in 78 patients, 2 points in 37 patients, 3 points in 7 patients, and 4 points in 5 patients; 74 patients experienced no improvement, and 3 patients deteriorated by one point. There was no statistical difference in myelopathy outcomes when comparing patients older and younger than 75 years of age. In two patients there was radiographic progression of kyphosis, but in no case was subsequent fusion required. Six patients without neck pain preoperatively developed new intractable neck pain after surgery.
Conclusions
Open door expansile laminoplasty is a safe and effective method for treating cervical spondolytic myelopathy. Laminoplasty is thus an alternative to anterior surgery that can be accomplished quickly with minimal blood loss, minimizing risks in elderly patients. 相似文献