颈椎单开门后方韧带复合体重建的临床观察

Hemiexpansive laminoplasty of cervical vertebra to reconstruct cervical posterior extensor setting

目的:探讨旁正中切口棘突重建颈椎管扩大成形术对ROM(颈椎总活动度)和颈部轴性症状的影响。方法:120例脊髓型颈椎病患者,行颈后旁正中切口颈椎管扩大棘突重建术60例(A组),行后正中切口单开门颈椎管扩大棘突切除术60例(B组)。分别记录两组患者椎管矢状径、颈部轴性症状、JOA评分及ROM。结果:术后随访2￣7年,平均3年6个月,两组对比,椎管矢状径间术前及随访时均无显著性差异;颈部轴性症状B组较A组明显增加(P<0.01);JOA评分两组的改善率均>75%,两组之间无显著性意义(P>0.05);ROMA组平均丢失0.9°,B组平均丢失7.4°(以过伸角丢失为主,平均为7.2°),B组丢失角度明显大于A组(P<0.01)。结论:颈椎后路单开门颈椎管扩大成形颈后旁正中切口棘突重建术,有助于术后颈部伸肌装置的功能重建,可减少术后颈椎活动度的丢失、减少术后颈部轴性症状。

Objective：To explore the influences of hemiexpansive laminoplasty of cervical vertebra and spinous process reconstruction with sidepostror approach on the ROM of cervical spine and axis symptom. Method：A prospective study of 120 patients with cervical spondylosis （myelopathic type） was performed,all cases were divided into two groups.60 patients（group A） were treated with hemiexpansive lanlinoplasty of cervical vertebra and spinous process reconstruction using side median approach,60 patients （group B） with hemiexpansive laminoplasty of cervical vertebra and resection of spinous process using posterior approach.The final evaluation between two groups was based on the cervical average ROM,axis symptom and JOA criteria. Result：The follow-up period was from 2 to 7 years,with a mean of 42 months.Cervical axis symptom could found more in group B than in group A （P〈0.01）.According to JOA criteria,the rate of improvement was higher over 75% in the both,there was no significant differences in the fraction of improvement（P〉0.05） between two groups,the average lose of hyperextensive angle was 0.9° in group A,7.4° in group B,there were significant differences between two groups （P〈0.01）.Conclusion：Hemiexpansive laminoplasty of cervial vertebra and spinous process reconstruction using side median approach is in favor of functional reconstruction of cervical posteror extensor setting,which can ensure better clinical results postoperatively.