单开门颈椎管扩大成形术开口间距与疗效对比观察

Comparative study of the distance of opening in single open-door cervical laminoplasty and surgical outcome

目的 了解颈椎管扩大成形术后椎管扩大程度及开口大小与疗效的关系。方法 对于脊髓型颈椎病、颈椎后纵韧带骨化、发育性颈椎管狭窄等患者共 72例行单开门颈椎管扩大成形术 ,其中5 8例获得随访 ,手术前、后均行CT扫描测量颈椎管矢状径 ,术后平均随访时间 35 .9个月。结果 JOA评分优良率 79.3%。术后疗效随C3 ～7椎管平均矢状径增加而改善 ,当椎管平均矢状径增加至 80 %左右时疗效最佳 ,继续增加椎管平均矢状径疗效无明显改善。结论 颈后入路单开门椎管扩大成形术并非开口间距越大疗效越好 ,当开口大小超过一定范围 ,术后症状改善不再明显 。

Objective To study the effect of the distance of opening and the degree of spinal canal expansion on the surgical outcome.Methods 72 cases were operated upon with expansive open-door laminoplasty of cervical spine due to ossification of cervical posterior longitudinal ligment (OPLL), developmental cervical stenosis (DCS), cervical spondylosis myelopathy (CSM) etc. 58 cases were followed up for an average of 35.9 months. Pre-and post-surgery cervical spine CT films were evaluated.Results The complete and considerate improvement rate was 79.3%. As the post-surgery average sagittal diameter of C 3～ 7 spinal canal increased, the effect was greatly improved. But the best results were obtained when an up to 80% increasing of the sagittal diameter was gained. However, no obvious further improvement was observed even though the sagittal diameter of the expansive spinal canal continued to be enlarged.Conclusion Although the results after expansive open-door laminoplasty of cervical spine improve with the distance of opening, it is not the case that the larger the distance of opening is, the better the surgical outcome. When the increasing of the distance of opening exceeds 80%, the results would stop improving significantly further more, but the rate of post-surgery complications would increase instead.