保留单侧肌肉韧带复合体颈椎椎板成形术近期疗效的比较研究

目的比较颈后路传统单开门（锚定组）和保留单侧肌肉韧带复合体、重建颈伸肌附着点单开门（保留组）椎板成形术的近期疗效。方法2006年11月-2008年11月，82例因脊髓型颈椎病行颈后路椎板成形术，46例行保留法，36例行锚定法，比较术前、术后3个月和12个月脊髓功能JOA评分、颈部VAS疼痛评分、颈椎功能指数（NDI）评分，术前术后颈椎过屈位曲度、过伸位曲度、活动度和中立位曲度，CT观察椎板门轴愈合和保留组棘突-椎板骨愈合情况。结果2组术后脊髓功能JOA评分、疼痛VAS评分、颈椎过屈位曲度、过伸位曲度、活动度均较术前存在显著差异（P=0．00，0．00，0．03，0．00，0．00）。保留组术后3个月、12个月颈部VAS疼痛评分、过屈位曲度、过伸位曲度、活动度优于锚定组（P=0．00，0．03，0．01，0．00）。术中门轴有骨折的节段锚定组术后门轴愈合率优于保留组（P=0．00），保留组棘突-椎板愈合率和门轴愈合率之间有相关性（SpearmanR=0．254，P：0．00）。结论颈后路保留单侧肌肉韧带复合体椎板成形术可在缓解脊髓症状的同时减轻轴性症状，保留颈椎运动功能，其门轴愈合率低于传统椎板成形术。

Short-term Efficacy of Cervical Laminoplasty Preserving the Unilateral Ligament with Muscle Complex:Comparative Study

Objective To compare the short term efficacies of traditional open door cervical laminoplasty and cervical laminoplasty with unilateral preservation of the muscular ligament complex and reconstruction of the insertion of cervical extensive muscle. Methods From November 2006 to November 2008, 82 patients with cervical spondylotie myelopathy received cervical laminoplasty in our hospital; among them, traditional open door cervical laminoplasty was performed on 36 cases （anchor group） , and cervical laminoplasty preserving the unilateral ligament and muscle complex was carried out in 46 patients （ preservation group）. The pre-operative, and 3 and 12 month postoperative JOA, VAS, and NDI, as well as maximum cervical flexion/extension angles and range of motions were compared between the two groups. During follow up, the union of the lamina hinge and that of spinous process lamina in the preservation group were observed by CT scanning. Results In both the groups, the JOA, VAS, and maximum cervical flexion/extension angles and motion range were improved significantly after the treatments （ P = 0.00, 0.00, 0.03, 0.00, and 0.00 respectively）. Furthermore, the 3 and 12 month postoperative VAS, maximum cervical flexion/extension of the preservation group were superior to those in the anchor group （ P = 0.00, 0.03, 0.01 , and 0.00 respectively）. Whereas, the postoperative union of the lamina hinge in the anchor group was superior to that in the preservation group （ P = 0.00）. In the preservation group, the rate of spinous process lamina union was related with the rate of lamina hinge union （ Spearman R = 0. 254, P = 0.00）. Conclusions By cervical laminoplasty preserving the unilateral ligament and muscle complex, both spinal and axial symptoms can be alleviated while maintaining the cervical kinetic functions. The lamina hinge union rate of the procedure is lower than that of the traditional open door technique.