摘要
目的探讨颈椎后路单开门椎管扩大成形术范围延至寰椎的手术指征。 方法筛选2005年9月－2010年1月收治的颈椎C3～7或C2～7单开门椎管扩大成形术后，因C1～4范围内狭窄导致脊髓损害症状不缓解或缓解后再次加重，再手术将减压节段延伸至C1节段的后纵韧带骨化患者，排除因手术本身原因所致的再手术者，共17例作为研究组，并与因颈椎管狭窄症行C2～7减压联合C1后弓切除术患者15例（对照组）进行比较。两组患者性别、年龄、病程等一般资料比较差异均无统计学意义（P 〉 0.05），具有可比性。根据患者影像学资料评估其手术前后颈椎曲度及脊髓受压情况；应用日本骨科协会（JOA）脊髓功能17分评分表和Frankel分级评价患者手术前后神经功能情况；通过Hirabayashi等方法评估术后神经功能改善情况。 结果研究组17例患者中，初次行C3～7椎管扩大成形8例，其中3例存在C1、2节段狭窄，脊髓周围脑脊液信号不连续；5例在C2～4节段有最大前后径〉 7.0 mm的致压物。初次行C2～7椎管扩大成形术9例，C2～4节段均有最大前后径〉 7.0 mm的致压物。17例患者再次手术将减压节段延至C1，术后随访时间35～61个月，平均45.6个月；颈椎曲度情况：术前为颈椎前凸11例、直形颈椎4例、颈椎后凸2例，术后有2例颈椎前凸变为直形颈椎，1例直形颈椎变为后凸；神经改善率优8例，良7例，可2例。对照组术前C2～4节段均有最突出部位前后径〉 7.0 mm的致压物；术后随访时间30～58个月，平均38.7个月；颈椎曲度情况：术前为颈椎前凸13例、直形颈椎2例，术后有1 例颈椎前凸变为直形颈椎；神经功能恢复率为优8例，良6例，可1例。术前及末次随访时两组组间比较JOA评分差异均无统计学意义（P 〉 0.05），两组末次随访时JOA 评分均较术前显著改善（P 〈 0.05）。 结论对于颈椎后路单开门椎管扩大成形术范围延至寰椎的手术指征，初步提出以下几点：①上颈椎（C1、2）椎管狭窄，判定标准为：C1后弓下缘以上部分脊髓周围脑脊液信号不连续，且椎管实际前后径〈 8.0 mm。②C2～4椎体下缘节段存在巨大致压物，最突出部位直径 〉 7.0 mm，无法通过颈椎前路手术去除致压因素，或前路手术风险性极大时。
ObjectiveTo determine the surgical indications for posterior expansive open-door laminoplasty （EOLP） extended to the C1 level. MethodsSeventeen patients undergoing C3-7 or C2-7 open-door laminoplasty were included as the case group between September 2005 and January 2010, whose spinal cord injury symptoms were not alleviated or aggravated again because of the cervical stenosis at C1-4 level, and the causes of the surgery itself were eliminated, all of these patients underwent reoperation with decompress upward to C1 level. Fifteen patients with cervical stenosis who underwent C2-7 laminoplasty and C1 laminectomy were selected as the control group. There was no significant difference in gender, age, and disease duration between 2 groups （P 〉 0.05）. The pre- and post-operative cervical curvature and spinal cord compression were evaluated according to the patients’ imaging data; the pre- and post-operative neurological recovery situation was evaluated by Japanese Orthopaedic Association （JOA） 17 score and spinal cord function Frankel grade; the neurological recovery rate （according to Hirabayashi et al. method） was used to assess the postoperative neurological recovery situation. ResultsIn the case group, 8 patients underwent primary C3-7 laminoplasty. In 3 of these patients, there was a cervical stenosis at C1, 2 level, and discontinuous cerebrospinal fluid around the spinal cord was observed; 5 of them with a compression mass which diameter was exceed 7.0 mm in the C2-4 segments. The remaining 9 patients in the case group underwent primary C2-7 laminoplasty, and the diameter of the compression mass was exceed 7.0 mm in the C2-4 segments. In all 17 patients of the case group, reoperation was performed with the decompression range extended to the C1 level, and the follow-up time was 35-61 months with an average of 45.6 months. Cervical curvature： there were 11 cases of cervical lordosis, 4 cases of straight spine, and 2 cases of cervical kyphosis before operation; but after operation, 2 cases of cervical lordosis became straight spine and 1 straight case became kyphosis. The postoperative neurological improvement was excellent in 8 cases, good in 7, and fair in 2. In the control group, all the patients had a compression mass which anteroposterior diameter was exceed 7.0 mm in the C2-4 segments before operation. The follow-up time was 30-58 months with an average of 38.7 months. Cervical curvature： there were 13 cases of cervical lordosis and 2 cases of straight spine before operation; but after operation, 1 case of cervical lordosis became straight spine. The postoperative neurological improvement was excellent in 8 cases, good in 6, and fair in 1. No significant difference was found in the JOA score at pre- and post-operation between 2 groups （P 〉 0.05）; however, there were significant differences （P 〈 0.05） in the JOA score between at last follow-up and at preoperation. ConclusionThe initially surgical indications which can be used as a reference for EOLP extended to C1 are as follows：① Upper cervical （C1, 2） spinal stenosis： C1 posterior arch above the lower edge part of cerebrospinal fluid around the spinal cord signal is not continuous, and the anteroposterior diameter of the spinal canal actual is less than 8.0 mm as judgment standard. ②There is a huge compression at the lower edge of C2-4 vertebrae, and the most prominent part of the diameter is exceed 7.0 mm, which can not be removed through the anterior cervical surgery, or the operation is high-risk.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2013年第10期1214-1220,共7页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
单开门椎管扩大成形术
椎管减压
颈椎管狭窄
后纵韧带骨化
Single open-door laminoplasty
Spinal decompression
Servical stenosis
Ossification of posterior longitudinal
ligament
