多节段脊髓型颈椎病术前颈椎曲度对椎管扩大椎板成形术术后神经功能恢复影响

目的探讨多节段脊髓型颈椎病患者术前颈椎曲度与椎管扩大椎板成形术术后神经功能之间的相关性。方法选取2013年1月—2015年12月在第二军医大学附属长征医院实施椎管扩大椎板成形术的70例多节段脊髓型颈椎病患者作为研究对象进行回顾性分析。按照患者术前X线片中的颈椎曲度将患者分为曲度正常组(A组)、曲度变直组(B组)、轻度曲度后凸组(C组),比较3组患者术后各节段脊髓后移距离、神经功能恢复率,并探讨术前颈椎曲度、术后脊髓后移距离与神经功能恢复率之间的相关性。结果 3组患者术后各节段脊髓后移距离组间差异无统计学意义(P0.05)。3组患者术前、术后的组间日本骨科学会(JOA)评分、神经功能恢复率差异均无统计学意义(P0.05);与术前相比,术后3组患者的JOA评分均明显增高,差异具有统计学意义(P0.05)。颈椎曲度与神经功能恢复率、脊髓后移距离之间无相关性。结论术前颈椎曲度变直及轻度后凸的多节段脊髓型颈椎病患者在实施椎管扩大椎板成形术后脊髓神经功能均可改善,曲度变直及轻度后凸可能不再是多节段脊髓型颈椎病行椎管扩大椎板成形术的禁忌证。

Effect of preoperative cervical curvature on recovery of nerve function after expansive laminoplasty in multi-segmental cervical spondylotic myelopathy

Objective To explore the correlation between preoperative cervical curvature and recovery of nerve function after expansive laminoplasty in multi-segmental cervical spondylotic myelopathy patients. Methods From January 2013 to December 2015, clinical data of the 70 multi-segmental cervical spondylotic myelopathy patients undergoing expansive laminoplasty in Changzheng Hospital were analyzed retrospectively. According to the cervical curvature on preoperative roentgenographs, the patients were divided into normal curvature group(group A), straight curvature group(group B), slight kyphosis group(group C). Postoperative posterior displacement of the spinal cord at each segment and recovery rate of nerve function were compared between the 3 groups. The correlation was explored between the preoperative cervical curvature, nerve function recovery rate and postoperative posterior displacement of the spinal cord. Results There was no significant difference in postoperative posterior displacement of spinal cord at each segment between the 3 groups(P> 0.05). Further, there were no significant difference between the 3 groups in preoperative Japanese Orthopaedic Association(JOA) score, post-operative JOA score and nerve function recovery rate(P> 0.05). In addition, there was a significant difference between postoperative and preoperative JOA score in each group(P< 0.05). There was no significant correlation between the preoperative cervical curvature, nerve function recovery rate and postoperative posterior displacement of spinal cord(P> 0.05). Conclusion Nerve function of multi-segmental cervical spondylotic myelopathy patients with preoperative straight cervical curvature and mild kyphosis can be improved after expansive laminoplasty. Straight curvature or mild kyphosis may no longer be a contraindication of expansive laminoplasty for multi-segmental cervical spondylotic myelopathy.