标本模拟微创颈椎管成形后椎管容积变化及临床意义

背景：单开门和双开门颈椎管扩大成形是目前治疗多节段脊髓型颈椎病的主要方法，但它们均存在棘突韧带复合体等结构破坏大甚至完全切除、可能影响疗效的问题。 目的：观察微创颈椎管成形后椎管容积的扩大情况，分析减压效果及临床疗效。 方法：①12个C5椎骨干燥标本模拟微创颈椎管成形，后移1，2，3 mm组双侧椎板“长条状”开槽、棘突及椎板均匀后移1，2，3 mm，以退让前为对照组。采用螺旋CT薄层扫描，并利用CT工作站的测量工具分别测量各组骨性椎管容积。②2010年9月至2011年9月，36例脊髓型颈椎病患者在郑州大学第一附属医院骨科行微创颈椎管成形治疗。按照日本矫形外科学会JOA评分法，自身对照评价治疗前后脊髓神经功能恢复情况。 结果与结论：①对照组骨性椎管容积平均为(1 592±331) mm3，后移1，2，3 mm组的骨性椎管容积分别平均为(1 727±357) mm3、(1 861±386) mm3、(2 001±416) mm3；后移1，2，3 mm组的椎管容积改善率分别为(8.53±1.05)%、(16.93±1.78)%、(25.75±2.97)%，各组之间比较差异均有显著性意义(P < 0.05)。②36例患者治疗前JOA评分为7.97±1.73，末次随访时JOA评分为13.14±1.74，差异有显著性意义(P < 0.05)，JOA评分平均改善率为(58.55±13.71)%，疗效评估优良率为83.3%(优9例，良21例，一般6例)。结果提示，标本模拟可较好反映微创颈椎管成形后的椎管容积变化，为其临床实现有效减压提供可靠的指导依据。

Spinal canal volume change and clinical significance of cervical minimally invasive lamionplasty with specimen simulation

BACKGROUND: Single-door and double-door of cervical laminopalsry are now the main methods for the treatment of multiple segments cervical spondylotic myelopathy, but they all have the same question that with the spinous process ligament complex damaged, even completely resected and affect the curative effect OBJECTIVE:To observe the canal volume expansion and to analyze the effect of decompression and curative effect after cervical minimally invasive laminoplasty. METHODS: Twelve dry specimens of the fifth cervical vertebra were selected to simulate cervical minimally invasive lamionplasty. In the concession 1, 2 and 3 mm groups, the bilateral vertebral plate long strip slotted, spinous and vertebral plate retruded by 1 mm, 2 mm and 3 mm respectively, and the specimens before concession were regarded as the control group. The specimens were thin-slice scanned with spiral CT, the volume of bony cervical canal was measured with the tools in CT workstation respectively. Forty-six cervical spondylotic myelopathy patients received cervical minimally invasive laminoplasty from September 2010 to September 2011 in the Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University. According to Japanese Orthopaedic Association scoring system, neurologic function was evaluated before and after surgery through self-control. RESULTS AND CONCLUSION:The average cervical bony spinal canal volume of the control group was       (1 592±331) mm3, the average cervical bony spinal canal volumes of concession 1 mm, 2 mm and 3 mm groups were (1 727±357) mm3, (1 861±386) mm3 and (2 001±416) mm3 respectively; the improvement rates of canal capacity of concession 1 mm, 2 mm and 3 mm groups were (8.53±1.05)%, (16.93±1.78)% and (25.75±2.97)% respectively, and there was significant difference between groups (P < 0.05). The Japanese Orthopaedic Association score of the 36 patients was (7.97±1.73) points before treatment, and (13.14±1.74) in the final follow-up, there was significant difference (P < 0.05); the Japanese Orthopaedic Association score improvement rate was (58.55±13.71)%, the excellent and good rate was 83.3% (9 excellent, 21 good and 6 fair). Specimen simulation can better reflect the spinal canal volume after cervical minimally invasive lamionplasty, and provide a reliable basis for guiding effective decompression.