颈3椎板切除单开门成形术对颈椎轴性症状的影响

Impact on cervical axial symptom of modified open-door laminoplasty with C_3 laminectomy

目的对传统C3～7椎板成形术进行改良,探讨C3切除、C4～7成形的改良椎板成形术是否相对于传统的椎板成形术能有效降低术后颈椎轴性症状的发生。方法2002年3月至2005年3月,接受C3椎板切除的椎板成形术并获得完整随访的44例颈椎病患者作为试验组(A组),平均随访时间为18个月(12～27个月);同期接受传统椎板成形术并获得完整随访的50例患者作为对照组(B组),平均随访时间为27个月(12～40个月)。对两组患者手术前后的JOA评分、颈椎曲度指数、颈椎活动度及轴性症状严重程度进行比较评估。结果JOA评分恢复率,A组患者为59.2%±11.3%,B组患者为60.1%±19.5%,两组差异无统计学意义。A组术后有明显轴性症状患者的比例为22.7%,B组为54.0%,两组比较差异有统计学意义(P<0.05)。A组患者术后颈椎曲度指数丢失2.1%±1.6%,B组患者术后颈椎曲度指数丢失6.4%±3.2%,两组患者手术前后颈椎曲度的变化差异有统计学意义(P<0.01)。A组患者术后颈椎活动度丢失4.6°±4.0°,B组患者术后颈椎活动度丢失11.6°±7.8°,两组差异有统计学意义(P<0.01)。结论C3椎板切除的椎板成形术在获得良好神经减压效果的同时,可以维持颈半棘肌结构和功能的完整性,减少对颈椎后伸机制的破坏,从而降低术后颈椎轴性症状的发生率。

Objective To verify whether the modified open-door laminoplasty with C3 laminectomy is effectve in preventing postoperative axial symptom. Methods Since March 2001 to March 2005, 44 patients who underwent modified open-door laminoplasty with semispinalis cervicis insertion intact were included in this study （group A）. 50 patients who underwent conventional open-door laminoplasty in the authors＇ department during the same period were served as control （group B）. Preoperative and postoperative Japanese Orthopedic Association （JOA） scores, the degree of axial symptom, ranges of neck motion, cervical curvature index were recorded and compared. Results The average JOA recovery rate was 59.2%±11.3% for group A and 60.1%±19.5% for group B. There was no significant difference in JOA recovery rate between two groups. The rate of patients with evident axial symptoms was 22.7% in group A and 54.0% in group B, and the difference was statistically significant （P〈 0.05）. Loss of cervical curvature indices was 2.1%±1.6% in group A and 6.4%±3.2% in group B, and the difference was of statistically significant （P〈0.01）. At the same time, loss of ranges of neck motion was 4.6°±4.0° in group A and 11.6°±7.8° in group B, significant difference was also seen （P〈 0.01）. Conclusion Modified open-door laminoplasty with C3 laminectomy was less invasive to the posterior extensor mechanism and can preserve semispinalis cervicis insertion intact. This new procedure is effective in preventing postoperative axial symptoms with adequate decompression of the spinal cord.