后路单开门钉板固定联合Key-hole技术治疗混合型颈椎病的临床疗效研究

The clinical efficacy of posterior cervical open-door expansive laminoplasty combined with Key-hole technique for the treatment of mixed cervical spondylosis

目的探讨颈椎后路单开门钉板固定联合Key-hole技术治疗混合型颈椎病的临床疗效。方法回顾性队列研究。回顾性分析2016年1月至2022年6月济宁医学院附属医院脊柱外科所收治的同时具有脊髓和神经根压迫症状的混合型颈椎病且具有完整随访资料的128例患者的临床资料。其中男90例,女38例,年龄(58.5±9.8)岁。其中2018年2月前采用后路单开门钉板固定(单开门组)技术治疗72例,2018年2月后采用后路单开门钉板固定联合Key-hole技术(联合组)治疗56例。术前两组患者在年龄、日本骨科协会(JOA)评分、疼痛视觉模拟评分(VAS)、Cobb角方面差异均无统计学意义,具有可比性。比较两组患者手术时间、术中出血量、术后JOA评分、VAS评分及影像学Cobb角。结果两组患者均顺利完成手术。单开门组手术时间[M(Q_(1),Q_(3))]为89.0(68.5,104.5)min,联合组为90.0(72.8,108.8)min,两组间差异无统计学意义(P=0.640);单开门组术中出血量为100(100,200)ml,联合组为100(100,200)ml,两组间差异无统计学意义(P=0.680),术后两组JOA评分均较术前明显增加,而VAS评分均明显降低,差异均有统计学意义(均P<0.05)。末次随访时,联合组JOA评分及VAS评分均优于单开门组,差异均有统计学意义(均P<0.05)。结论后路单开门钉板固定联合Key-hole技术治疗混合型颈椎病,可有效解除颈髓和神经根的压迫因素,而不会导致颈椎失稳。

Objective To investigate the clinical efficacy of posterior cervical open-door expansive laminoplasty combined with Key-hole technique in treating mixed cervical spondylosis.Methods A retrospective cohort study.A retrospective analysis was made of 128 cases of mixed cervical spondylosis with symptoms of spinal cord and nerve root compression and complete follow-up data admitted to the Department of Spinal Surgery,Affiliated Hospital of Jining Medical University from January 2016 to June 2022.Of the patients,there were 90 males and 38 females with a mean age of(58.5±9.8)years.Before February 2018,72 cases were treated with posterior cervical open-door expansive laminoplasty(single-door group),and after February 2018,56 cases were treated with posterior cervical open-door expansive laminoplasty combined with Key-hole technique(combined group).There was no significant difference between the two groups in age,Japanese Orthopaedic Association(JOA)score,visual analogue scale(VAS)score of pain and Cobb angle of imaging before operation.The operation time,intraoperative blood loss,postoperative JOA score,VAS score and Cobb angle of imaging were compared between the two groups.Results Both groups of patients successfully completed the operation.Operation time[M(Q_(1),Q_(3))]:89.0(68.5,104.5)min in the single-door group and 90.0(72.8,108.8)min in the combined group,there was no statistical difference between the two groups(P=0.640).The intraoperative blood loss in the single-door group was 100(100,200)ml,and it was 100(100,200)ml in the combined group,there was no significant difference between the two groups(P=0.680).Postoperative JOA scores increased significantly,while VAS scores decreased significantly in both groups.At the last follow-up,the JOA and VAS scores of the combined group were better than those of the single-door group(both P<0.05).Conclusion The posterior cervical open-door expansive laminoplasty combined with Key-hole technique for the treatment of mixed cervical spondylosis can effectively remove the compression on the cervical spine without causing cervical instability.