改良颈椎后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病的对比研究

目的:保留颈半棘肌肌止,颈7椎板造穹隆,锚定法单开门椎管扩大的椎管成形术式和传统的单开门成形术治疗多节段颈椎病的疗效比较。方法:分析应用改良单开门椎管成形术与传统单开门椎管成形术的40例治疗多节段颈椎病患者的临床资料。改良组25例,传统组15例。记录患者手术时间、术中出血量,术前术后JOA评分及颈部痛视觉模拟评分(VAS),术后随访时颈椎总活动度及轴性症状进行比较。结果:两种方法手术时间,术中出血量无统计学差异(P>0.05);术前JOA评分、VAS评分差异无统计学意义(P>0.05);术后JOA评分、神经功能改善率改良组与传统组相比有升高趋势;改良组术后VAS评分明显低于传统组(P<0.05);末次随访时颈椎总活动度改良组角度大于传统组(P<0.05);传统组8例(50%)患者出现轴性症状,改良组8例(33%),两组比较有统计学意义(P<0.05)。结论:保留颈半棘肌肌止,颈7椎板造穹隆,锚定法单开门椎管扩大的椎管成形术能明显减少术后轴性症状的发生,改善颈部疼痛,增加颈椎活动度,具有一定的神经功能改善作用。

Comparison of modified and traditional posterior cervical laminoplasty treating cervical spondylotic myelopathy

Objective:To compare the effects of modified expansive open-door laminoplasty and traditional single door on cervical spondylotic myelopathy.Methods:40 cases with cervical spondylotic myelopathy were selected.25 patients were included in the modified group.15 patients were included into the traditional group.The operation time,volumeof blood loss,preoperative and postoperative follow-up of the JOA score and neck pain VAS,range of motion were recorded for the two groups.Results:There was no significant difference in operation time,intraoperative blood loss,preoperative JOA score,VAS score (P ＞ 0.05).There were a rising trend in postoperative JOA score,nerve function period,but no significant difference (P＞ 0.05).Postoperative VAS score of the modified group was significantly lower than the traditional group's (P ＜ 0.05).Cervical total at the time of the last follow-up activity improved Angle of the modified group was greater than the traditional group's (P ＜ 0.05).The traditional group had more axial symptoms (8/16 50％) than the modified group(8/24 33％) (P ＜ 0.05).Conclusion:The modified expansive open-door laminoplasty can obviously reduce postoperative axial symptoms and the occurrence of neck pain and have certain improvement on neurological function.