摘要
[目的]对传统C3～7椎板成形术进行改良,观察改良手术疗效,探讨其能否有效降低并发症的发生。[方法]改良椎板成形术治疗脊髓型颈椎病20例(A组),A组患者平均年龄65.7岁(45～83岁);男14例,女6例;平均随访时间为18个月(12～27个月)。传统术式对照组(B组)为本院同期行传统C3～7椎板成形术的18例患者,B组患者平均年龄59岁(46～75岁);男11例,女7例;平均随访时间为25个月(12～50个月)。对两组患者手术前后的JOA评分、颈椎曲度角度、颈椎活动度及轴性症状严重程度进行比较评估。[结果]JOA评分恢复率,A组患者为46.5%,B组患者为54.1%,两组差异无统计学意义(P>0.05)。A组术后有明显轴性症状患者的比例为10%,B组为44.4%,两组比较差异有统计学意义(P<0.05)。A组患者术后颈椎曲度Cobb’s角11.2°±9.2°,B组患者术后颈椎曲度Cobb’s角10.9°±10.1°,A组和B组患者手术前后颈椎曲度的变化差异无统计学意义(P>0.05)。A组患者术后颈椎活动度丢失6.9°±4.0°,B组患者术后颈椎活动度丢失11.6°±7.8°,两组差异有统计学意义(P<0.01)。[结论]C3椎板切除保留C2棘突半棘肌附着、同时保留C7棘突颈背肌肉附着的颈椎管扩大椎板成形术能获得良好神经减压效果,同时可以最大程度维持颈半棘肌和颈背肌结构和功能的完整性,减少对颈椎后伸机制和颈椎稳定机制的破坏,从而保留颈椎的活动度和降低术后颈椎轴性症状的发生。
[ Objective] To modify the traditional C3-7 laminoplasty and observe the effect of the modified laminoplasty. To verify whether the modified open - door laminoplasty is effective in preventing postoperative complications. [ Methods ] Twenty cervical spondylotic myelopathy patients who underwent modified open - door laminoplasty were included in this study （ group A） . The average age of Group A were 65.7 years （age 45 -83） . Group A included 14 males and 6 females. The average follow - up time were 18 months （ range, 18 - 27months） . Control group （ group B） included 18 cervical spondylotic myelopathy patients who underwent traditional laminoplasty during the same period. The average age of Group B were 59 years （ age 46 - 75 ） . Group A included 11 males and 7 femalos. The average follow - up time were 25 months （ range, 12 -50） . Preoperative and postoperative Japanese Orthopedic Association （JOA） scores, cervical curvature angle, ranges of neck motion, the degree of axial symptom were recorded and compared. [ Results] The mean postoperative JOA score recovery rate of group A and B was about 46. 5% and 54. 1% respectively. There was no significant difference between them （ P 〉0. 05） . The rate of patients with evident axial symptoms was 10% in group A and 44. 4% in group B, and the difference was not statistically significant （P 〉0. 05） . Loss of cervical curvature Cobb＇ s angle was 11.2° ± 9. 2° in group A and 10. 9° ± 10.1° in group B, and there was no significant difference between them （P 〉0. 05） . At the same time, loss of ranges of neck motion was 4. 6° ±4. 0° in group A and 11.6° ±7. 8 °in group B, significant difference was also seen （ P 〈 0. 01 ） . For group A, the ROM of the cervical spine decreased by 6. 9° ± 4. 0° comparing with the preoperative extent, and that of group B 11.6° ± 7. 8°. There was significant difference between them （ P 〈 0.01 ） . [ Conclusion ] Modified French door laminoplasty with C3 laminectomy preserve C2 spinous process SSC insertion and preserve C7 spinous process the nuchal muscles insertion is effective in neurological decompression. And it can maximumly maintain the structure and function of the semispinali scervicis and nuchal muscles. It is less invasive to the posterior extensor mechanism and the stabilization mechanism. This new procedure is effective in preventing postoperative axial symptoms with preservation of the ROM of the cervical spine.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2009年第17期1303-1306,共4页
Orthopedic Journal of China
关键词
颈椎病
椎板切除术
椎板成形术
cervical spondylosis
iaminectomy
laminoplasty
