改良的单开门椎板成形术治疗脊髓型颈椎病

Modified open-door laminoplasty for the treatment of cervical spondylotic myelopathy

目的 介绍一种改良的单开门椎板成形术并观察其疗效和对颈椎稳定性的影响。方法 对19例颈椎病患者进行改良的单开门手术,手术前和随访时进行JOA评分并了解颈肩痛的发生率 和持续时间,CT／MRI测量椎管的矢状径,动力位摄片观察颈椎的稳定性,测量C2-C7 Cobb角观察颈 椎前凸的变化。结果 平均随访时间为13个月,JOA评分自术前平均为8.76提高到随访时12.12 分,改善率平均为45.4％;颈肩痛发生率26.3％;各节段椎管矢状径均有明显增大,而最大的增幅出 现在C5水平;颈椎前凸并没有发生明显改变;随访时的动力位摄片没有发现颈椎节段性不稳定。 结论 这种应用羟基磷灰石spacer并进行后方韧带重建的改良的单开门手术治疗脊髓性颈椎病效 果良好,由于保留了后方的棘突和韧带并进行了重建,术后颈椎的生理弧度和稳定性良好。

Objectives Introducing a modified open-door laminoplasty in the treatment of cervical sponylotic myelopathy, assess the efficacy and the influence on the stability of the spine. Methods 19 eases of cervical myelopathy underwent modified open-door laminoplasty, pre-and post-operative JOA score were assessed, measure the sagittal diameter of the canal from CT/MRI, assess the stability from dynamic radiography,measure the C2-C7 Cobb's angle to assess the lordosis of cervical spine. Results Mean follow-up duration were 13 months ,JOA score improved from 8.76 preoperatively to 12.12 postoperatively with the mean recovery rate of 45.4%. The incidence of post-operative axial pain was 26.3%. Sagittal diameter increased in all levels with the greatest change at the level of C5. No significant change of cervical lordosis. No segmental instability was found. Conclusion The modified open-door laminoplasty appears to be a good method for the treatment of cervical myelopathy. The post-operative stability is good due to the usage of hydroxya-patite spacer, preservation and reconstruction of posterior elements.