摘要
背景:各种原因所致的颈椎管狭窄症,主要治疗方法采取后路椎板切除术,但术后效果并不十分理想。目的:观察单开门椎管扩大成形术治疗各种颈椎管狭窄症患者的术后功能改善情况。设计:自身前后对照观察。单位:重庆医科大学附属第一医院骨科。对象:选择1995-05/2004-05重庆医科大学附属第一医院骨科收治的多节段颈椎管狭窄症患者32例,男22例,女10例。脊髓型颈椎病致椎管退变性狭窄12例,发育性椎管狭窄症18例,后纵韧带骨化症2例。方法:对32例颈椎管狭窄症患者采用单开门椎管扩大成形术治疗,获患者知情同意,术后随访半年。术前、术后2周及3个月脊髓功能采用日本骨科学会17分法评定(上肢和下肢功能分别为0～4分;上肢、下肢和躯干感觉分别为0～2分;膀胱功能分为0～3分。各项0分为严重障碍,最高分为正常)。术后2周,3个月及半年颈椎弧度、脊柱稳定性及并发症的观察采用X射线片观察。主要观察指标:①患者手术前后脊髓功能。②术后颈椎弧度、脊柱稳定性及并发症。结果:按意向处理分析,32例患者均进入结果分析。①患者手术前后脊髓功能评估:以日本骨科学会评估标准,12例脊髓型颈椎病致椎管退变性狭窄患者、18例发育性椎管狭窄症患者及2例后纵韧带骨化症患者,术后2周及3个月评分均显著高于术前(术前分别为5.2,5.7,5.5分;术后2周分别为9.2,9.7,9.4分;术后3个月分别为11.3,11.8,11.6分)。②术后颈椎弧度、脊柱稳定性及并发症变化:3例显示颈椎前屈弧度消失颈椎变直,但未见再关门及脊柱不稳现象;余29例未出现颈椎曲度异常及脊柱不稳现象。结论:应用单开门椎管扩大成形术治疗各种原因所致的颈椎管狭窄症患者,术后短期及3个月时,仍能改善和提高患者脊髓功能评分,对颈椎的稳定性不产生影响。
BACKGROUND：The main method to treat cervical spinal stenotic myelopathy caused by various factors is posterior lamninectomy, but the postoperative effect was not satisfactory. OBJECTIVE： To observe the postoperative functional reconstruction of the cervical vertebra of the patients with cervical spinal stenotic myelopathy through expansive open-door laminoplasty. DESIGN： An observational study by comparing the changes before and after the operation. SETTNG： Department of Orthopaedics of the First Affiliated Hospital of Chongqing Medical University. PARTICIPANTS： Totally 32 patients （22 male and 10 female） with multi-segment cervical spinal stenotic myelopathy were treated at the Department of Orthopaedics of the First Affiliated Hospital of Chongqing Medical University from May 1995 to May 2004. Twelve cases suffered from degenerative spinal canal stenosis caused by spinal cord type of cervical spondylosis, 18 cases suffered from developmental spinal canal stenosis and 2 from ossification of cervical posterior longitudinal ligament （OPLL）. METHODS： Altogether 32 cases were treated through expansive open- door laminoplasty to the cervical spine. These patients had been followed up for 6 months after the informed consent was obtained. The spinal func-tion was evaluated according to Japanese Orthopaedic Association 17 scores before operation, 2 weeks and 3 months after the operation respectively. The radian of the cervical vertebra, the stability of the spinal column and the complications were observed with X-ray. MAIN OUTCOME MEASURES： ① The spinal function of the patients before and after operation, ② The radian of the cervical vertebra, the stability of the spinal column and the complications after the operation. RESULTS： According to intention-to-treat analysis, all the 32 patients entered the stage of result analysis. ① Spinal function evaluation of the patients before and after the operation： According to the evaluation standard stipulated by Japanese Orthopaedic Association （JOA）, two weeks and three months after the operation, the scoring of the spinal function was signifi- cantly higher in 12 cases of cervical spondylosis myelopathy-induced degenerative stenosis, 18 cases of developmental spinal stenosis and 2 cases of ossification of cervical posterior longitudinal ligament （OPLL）（ The score was 5.2, 5.7, 5.5 points respectively before the operation; 9.2, 9.7 , 9.4 points respectively 2 weeks after the operation; and 11.3 , 11.8 , 11.6 points respectively 3 months after the operation）. ② The changes of the radian of the cervical vertebra, the stability of spinal column, and the complications after the operation： Radiographs indicated vanished cervical anteflexion curvature and straightened cervical vertebrae in three cases, but no re-closure or unstable spine happened. CONCLUSION： Expansive open-door laminoplasty for cervical spinal canal stenosis caused by various factors can still improve and increase the spinal functional evaluation scores shortly and 3 months after the operation, and it does not affect the stability of the cervical vertebrae.
出处
《中国临床康复》
CSCD
北大核心
2005年第26期221-223,共3页
Chinese Journal of Clinical Rehabilitation
