改良“Z”形椎管扩大成形术的并发症及其原因分析

目的:探讨颈椎后路改良"Z"形椎管扩大成形术并发症的发生率及其原因。方法:对行改良"Z"形椎管扩大成形术的56例患者的临床资料进行回顾性分析。采用JOA评分法、颈椎屈伸活动度、颈椎弯曲类型中前突型比率、相邻椎间的稳定性评价临床疗效,确定其手术并发症,分析其原因。结果:随访4～7年,平均5.2年。15例(26.8%)患者出现轴性症状,4例(7.1%)出现神经根麻痹,颈部旋转受限18例(32.1%),过伸受限13例(23.2%),屈曲受限10例(17.9%),侧屈受限8例(14.3%)。前突型比率由术前79.2%下降为73.9%,1例出现相邻椎间失稳。结论:改良大Z形单开门椎管扩大成形术后轴性症状、神经根麻痹及颈部活动受限较多见,其术后并发症的产生是多因素造成的。

Complications of expansive Z-open-door laminoplasty and causative analysis

Objective To explore the complication incidence of the expansive Z-open-door laminoplasty and their related causes.Method Retrospective reviews were done to 56 patients underwent the expansive Z-open-door laminoplasty.All the patients were evaluated by JOA scores,the range of motion in flexion-extension movement,cervical curvature and stability of adjacent segments.Determined the surgical complications and analyzed their causes.Results Fifty-six patients were followed up for 4~7 years,mean 5.2 years.Axial symptoms appeared in 15 cases（26.8%）,radiculopathy in 4 cases（7.1%）,cervical rotation was reduced in 18 cases（32.1%）,extension in 13 cases（23.2%）,flexion in 10 cases（17.9%）,lateral bending in 8 cases（14.3%）,respectively.The rate of procurvation reduced from 79.2% to 73.9%.Postoperative instability in adjacent segments happened in 1 case.Conclusion The postoperative complications of the expansive Z-open-door laminoplasty are axial symptoms,radiculopathy and restricted neck,due to multiple factors.