颈椎后路单开门与双开门椎管扩大修复多节段脊髓型颈椎病:颈椎活动度对比

Posterior cervical single door and double door laminoplasty for repair of multilevel cervical myelopathy:motion range of cervical vertebrae

背景:以往研究中,关于颈椎后路单开门及双开门椎管扩大成形修复多节段脊髓型颈椎病的研究大多仅从神经功能及临床相关指标上入手,缺乏一定全面性。目的:基于颈椎活动度探究颈椎后路单开门与双开门椎管扩大成形修复多节段脊髓型颈椎病的效果差异。方法:选取120例多节段脊髓型颈椎病患者,采取随机数字表法分为单开门组与双开门组,每组60例。单开门组给予单开门椎管扩大成形治疗,双开门组给予双开门椎管扩大成形治疗,对比两组出血量、术后住院时间、并发症发生率、神经功能改善情况、颈椎活动度及影像学变化。结果与结论:1与单开门组相比,双开门组患者手术出血量明显减少,术后住院时间、轴性症状发生率明显降低(P<0.05);2两组相比脑脊液侧漏、血肿、感染、麻痹等并发症发生率差异无显著性意义(P>0.05),双开门组轴性症状发生率明显低于单开门组(P<0.05);3两组神经功能治疗前JOA评分、治疗后JOA评分及神经功能改善率差异均无显著性意义(P>0.05),两组治疗后JOA评分均较治疗前显著升高(P<0.05);4两组治疗前颈椎活动度、屈曲、后伸角及椎管矢状径相比差异均无显著性意义(P>0.05)。两组治疗后与治疗前相比,颈椎活动度、屈曲角、后伸角均减小,椎管矢状径增大(P<0.05),但双开门组与单开门组相比椎管矢状径增大的程度更小,颈椎活动度保持程度更好;5结果提示,颈椎后路双开门椎管扩大修复多节段脊髓型颈椎病的效果显著,相比于单开门椎管扩大成形可缩短术后住院时间,减少术中出血量,降低轴性症状及颈椎活动度丢失率,临床可根据患者不同适应证开展治疗。

BACKGROUND：Previous studies on posterior cervical single door and double door laminoplasty for repair of multilevel cervical myelopathy mainly focus on neurological function and clinical parameters and lack of certain comprehensiveness.OBJECTIVE：To explore the effects of posterior cervical single door and double door laminoplasty for repair of multilevel cervical myelopathy.METHODS：We selected 120 patients with multilevel cervical myelopathy and randomly divided into single door group（n=60） and double door group（n=60）.The single door group underwent single door laminoplasty.The double door group underwent double door laminoplasty.The blood loss,length of stay,complication rate,neurological function improvement,motion range of cervical vertebrae and imaging changes were compared between the two groups.RESULTS AND CONCLUSION：（1） Blood loss was significantly less,length of stay was significantly shorter,and the incidence of axial symptom was significantly reduced in the double door group than in the single door group（all P〈0.05）.（2） No significant difference in complication rate such as side leakage of cerebrospinal fluid,hematoma,infection and paralysis was detected between the two groups（P〈0.05）.The incidence of axial symptoms was significantly less in the double door group than in the single door group（P〈0.05）.（3） There were no significant differences in preoperative Japanese Orthopaedic Association scores,postoperative Japanese Orthopaedic Association scores,and improvement in neurological function between the two groups（P〉0.05）.Postoperative Japanese Orthopaedic Association scores were significantly increased as compared with that preoperatively in both groups（P〈0.05）.（4） No significant difference in motion range of cervical vertebrae,inflexion,extension angle and sagittal diameter of spinal canal was detectable between the two groups（P〉0.05）.Motion range of cervical vertebrae,extension angle,and inflexion angle were smaller after treatment compared with that preoperatively in both groups（P〈0.05）.The increased degree of sagittal diameter of spinal canal was smaller,and the motion range of cervical vertebrae kept better in the double door group than in the single door group.（5） These results indicate that the effect of double door laminoplasty for repair of multilevel cervical myelopathy was significant.The double door laminoplasty can shorten the length of stay,reduce blood loss,axial symptoms,and loss rate of motion range of the cervical vertebrae.In the clinic,treatment can be carried out according to different indications.