单开门治疗脊髓型脊椎病和后纵韧带骨化症的疗效比较

目的比较单开门椎管扩大椎板成形术治疗脊髓型脊椎病和后纵韧带骨化症的疗效。方法选择2005年1月至2010年12月在苏州大学附属第一医院行open．doorELAP手术并获得完整随访的患者71例，手术开门减压节段均为C3～C7。其中21侧是后纵韧带骨化症（A组），另50例是脊髓型颈椎病（B组）。记录手术时间、术中出血量、术后轴性症状发生率，C5神经根麻痹及JOA（17分法）评分，在X线片测量颈椎活动度，在末次随访时颈椎CT片上测量椎板掀开角度，对两组进行比较。结果A组随访13-95个月，平均（46．5±35．8）个月；B组随访13—96个月，平均（47．7±36．4）个月。两组在手术时间、术中出血量、轴性症状发生率、Cs神经根麻痹以及术前JOA评分均无统计学差异（P〉0．05）。A组和B组术后随访时JOA评分较术前均有不同程度的改善，但A组改善率要低于B组（P〈0．05）。影像学资料显示两组患者术后活动度都有所丧失，但两组患者之间无统计学差异（P〉0．05）。两组患者末次随访时颈椎CT测量椎板掀开的角度分别为A组（38．04±4．76）。和B组（37．48±4．35）。两组间比较无统计学差异（P〉0．05）。结论单开门椎管扩大椎板成形术可以有效地治疗脊髓型颈椎病和后纵韧带骨化症，但是后纵韧带骨化症患者脊髓功能的恢复低于脊髓型颈椎病患者。

Efficacy Comparison of Single Door Treatment of Spinal Disease and Spinal Ossification of the Posterior Longitudinal Ligament

Objective To compare the clinical efficacy of cervical expansive open-door laminoplasty （open-door ELAP） for multi-segment cervical spondylotic myelopathy and ossification of posterior longitudinal ligament. Method From January 2005 to December 2010, a total of 71 cases underwent open-door ELAP and were fbllowed up well in the first affiliated hospital of soochow university hospital. The range of decompression segments includes C3-C7 in all patients. Twenty-one patients were diagnosed as ossification of posterior longitudinal ligament （group A）. Fifty patients were diagnosed as multi-segment cervical spondylotic myelopathy （group B）. The operation time, blood loss, JOA scores and incidence of axial symptoms were recorded. Preoperative and postoperative range of motion （ROM） in the cervical spine was measured on cervical radiographs. Angle of the opened laminae was measured according to CT during the period of last follow-up. Result Time of follow-up ranged 13-95 months, mean （46.5±35.8） months in group A and 13-96 months, mean （47.7±36.4） months in group B. No statistical difference was found in the mean operation time, blood loss, incidence of significant axial symptoms and C5 pal.sy, and preoperative JOA scores between the two groups （P〉0.05）. Postoperative JOA scores were improved in two groups without significant difference between two groups （P〉0.05）. However, the recovery rate of JOA scores in group A was significant lower than that in group B （P〈0.05）. Radiographically, both groups lost extension range of motion （ROM） following laminoplasty, but this change was not statistically significant （P〉0.05）. The angle of the opened laminae was （38.04±4.76）% in the group A and （37.48±4.35）% in the group B, showing no statistically significant difference （P〉0.05）. Conclusion Laminoplasty is an effective procedure for the treatment of Patients due to either multi-segment cervical spondylotic myelopathy or ossification of posterior, longitudinal ligament. However, recovery of neurological function of patients with ossification of posterior longitudinal ligament was less than that of patients with multi-segment cervical spondylotic myelopathy.