不同置板密度的单开门椎管成形术治疗多节段脊髓型颈椎病

目的 :比较后路连续放置椎板成形钢板单开门椎管成形术与后路间断放置椎板成形钢板单开门椎管成形术治疗多节段脊髓型颈椎病的近期疗效。方法:自2012年1月至2015年3月收治43例多节段脊髓型颈椎病患者,其中21例行后路连续放置椎板成形钢板单开门椎管成形术(连续组),22例行后路间断放置椎板成形钢板单开门椎管成形术(间断组),比较两组手术时间、术中出血量、住院时间、JOA评分、VAS评分、术后颈椎曲度、椎管矢状径、颈椎活动度、手术并发症及住院费用等,评价两种手术方式的疗效。结果:43例患者均获得随访,平均随访时间分别为(23.2±8.1)个月(连续组)和(23.3±8.0)个月(间断组)。两组手术时间、术中出血量、住院时间比较差异无统计学意义(P0.05)。两组JOA评分及VAS评分末次随访时较术前均明显改善(P0.05)。两组术后3 d和未次随访时颈椎矢状径均较术前明显改善(P0.05)。术后3 d和末次随访时差异无统计学意义(P0.05)。末次随访时两组颈椎活动度较术前减少(P0.05),组间比较差异无统计学意义(P0.05)。两组手术并发症比较差异无统计学意义(P0.05),两组住院费用有明显差异(P0.05)。结论:后路连续放置椎板成形钢板单开门椎管成形术与后路间断放置椎板成形钢板单开门椎管成形术治疗多节段脊髓型颈椎病神经功能改善相似,但间断放置椎板成形钢板组住院费用明显减少,节约了医疗资源。

Comparison of short-term curative effects of open-door laminoplasty with different plate density for the treatment of multi-segment cervical spondylotic myelopathy

Objective:To compare the short-term curative effect of posterior open-door laminoplasty between continuous placement of shaping plate and intermittent placement in treating multilevel cervical spondylotic myelopathy.Methods:From January 2012 to March 2015,43 patients with multi-segment cervical spondylotic cervical were treated with posterior open-door laminoplasty,21 patients with continuous placement of shaping plate(continuous group),22 patients with intermittent placement of shaping plate(intermittent group). Operative time,intraoperative blood loss,JOA score,VAS score,postoperative spinal sagittal diameter and cervical curvature,postoperative cervical activity,complications,hospitalization expenses etc. were observed.Results:The patients of two groups were followed up with an average of (23.2±8.1) months and (23.3±8.0) months in continuous group and intermittent group,respectively. There was no significant difference in operative time,intraoperative blood loss,hospitalization time between two groups(P>0.05). JOA and VAS scores of all patients at final follow-up were obviously improved than preoperative(P<0.05). Postoperative spinal sagittal diameter at 3 days and final follow-up were obviously improved(P<0.05),and there was no significant difference between postoperative at 3 days and final follow-up(P>0.05). Cervical activity of all patients at final follow-up was decreased than preoperative(P<0.05),but there was no significant difference between two groups(P>0.05). There was no significant difference in postoperative complication and there was significant difference in hospitalization expenses between two groups.Conclusion:Posterior open-door laminoplasty with continuous or intermittent placement of shaping plate have similar clinical effects in ameliorating nerve function for the treatment of multilevel cervical spondylotic myelopahty. However,the hospitalization expenses of intermittent group is obviously reduced,and the medical resources can be saved.