选择性椎板成形术和传统椎板成形术治疗脊髓型颈椎病的中期疗效

目的对比选择性椎板成形术和传统椎板成形术治疗脊髓型颈椎病的中期疗效。方法回顾性分析2010年9月—2015年12月收治的130例脊髓型颈椎病(CSM)患者临床资料,其中67例采用选择性椎板成形术治疗(试验组),63例采用传统椎板成形术治疗(对照组)。记录并比较2组手术时间、术中出血量、并发症发生情况,以及手术前后双手10 s握拳次数、双手握力、日本骨科学会(JOA)评分、C_(2～7) Cobb角、C2～5 Cobb角、C_(5～7) Cobb角、C7倾斜角、T1倾斜角、C_(2～7)矢状位平衡(SVA)和K线角。结果试验组手术时间、术中出血量均少于对照组,差异有统计学意义(P 0.05)。2组患者末次随访时双手10 s握拳次数、双手握力及JOA评分均较术前改善,差异有统计学意义(P 0.05)。末次随访时,对照组C_(2～7) Cobb角较术前减小、C_(2～7) SVA较术前增大,而试验组无显著改变,2组相比差异有统计学意义(P 0.05)。末次随访时,试验组7例(7/67,10.4%)发生轴性症状,对照组20例(20/63,31.7%)发生轴性症状,试验组轴性症状发生率显著低于对照组,差异有统计学意义(P 0.05)。结论 2种术式治疗CSM中期临床疗效满意。选择性椎板成形术在保证手术疗效的前提下,可缩短手术节段,减少对颈后部肌肉韧带的损伤,降低术后轴性症状的发生率。

Mid-term efficacy of selective laminoplasty and traditional laminoplasty for cervical spondylotic myelopathy

Objective To observe and compare the medium-term efficacy between selective laminoplasty and traditional laminoplasty for the treatment of cervical spondylotic myelopathy(CSM). Methods The clinical data of 130 CSM patients recruited from September 2010 to December 2015 were retrospectively analyzed, of whom 67 were treated with selective laminoplasty(experiment group) and 63 were treated with traditional laminoplasty(control group). The operation time, intraoperative blood loss, complications, as well as number of finger grip and release test in 10 s, grip strength, Japanese Orthopaedic Association(JOA) score, C_2-7 Cobb''s angle, C_2-5 Cobb''s angle, C_5-7 Cobb''s angle, C₇ slope, T₁ slope, C_2-7 sagittal vertical axis(SVA) and K-line tilt at pre-and post-operative were recorded and compared between the 2 groups. Results The operation time and intraoperative blood loss of the experiment group were less than those of the control group, and the differences were statistically significan(t P<0.05). At the final follow-up, the number of finger grip and release test in 10 s, the grip strength and JOA score of both groups were improved compared with those at pre-operation, and the differences were statistically significant(P<0.05). At the final follow-up, the C_2-7 Cobb''s angle decreased and C_2-7 SVA increased compared with pre-operation in the control group, but there was no significant change in the experiment group; there were significant differences between the 2 groups(P<0.05). At the final follow-up, 7 patients(7/67, 10.4%) had axial symptoms in the experiment group, while 20 (20/63, 31.7%) in the control group. The incidence of axial symptoms was significantly lower in the experiment group than in the control group, and the difference was statistically significant (P<0.05). Conclusion The mid-term clinical effect of 2 surgical methods for CSM is satisfactory. Selective laminoplasty can shorten the operative segment, reduce the injury to the posterior cervical muscles and ligaments, and reduce the incidence of axial symptoms.