保留C_2棘突半棘肌附着的颈椎管扩大椎板成形术

Cervical bilateral open-door extended laminoplasty with complete preservation of semispinalis cervicis insertion in spinous process of C_2

目的:观察完整保留C2棘突半棘肌附着的颈椎管扩大椎板成形术的手术疗效。方法:A组27例行改良颈椎板成形术,即显露时保留半棘肌在C2棘突上的附着,切除C3椎板,C4～C7双开门术式。B组33例行常规颈椎板成形术,即分离切断C2棘突半棘肌附着,关闭时缝合重建,C3～C7双开门成形术式。比较两组手术时间、出血量、术后神经功能、并发症、颈椎曲度和屈伸活动度(ROM)、病人自我评价。JOA计分法评价神经功能、Cobb’s法测量颈椎曲度和ROM。结果:所有病例随访至少1年,A、B组术后JOA评分平均改善率分别为63.01%、60.83%(P>0.05)。手术时间A、B组分别123±17.4min、175±12.7min,出血量分别380±18.6ml、564±21.5ml;A组较B组手术时间短、出血量少(P<0.05)。术后1年A、B组ROM分别保留术前的81.6%和65.3%(P<0.01);A组无后凸畸形、手术并发症少、局部症状轻微。结论:改良颈椎管扩大椎板成形术脊髓减压满意,手术时间短、出血量少,无严重并发症;而且有助于早期颈椎功能锻炼、维持良好颈椎曲度和ROM。

Objective： To evaluate the clinical effects of cervical bilateral open-door extended laminoplasty with complete preservation of semispinalis cervicis （SSC） insertion in spinous process of C2. Methods： 27 cases were treated with the C4-C7 segmental bilateral open-door extended laminoplasty with complete preservation of SSC insertion in spinous process of C2 combined with C3 laminectomy （group A）. 33 cases were performed C3 -C7 laminoplasty by detaching the SSC from the C2 spinous process and reattaching to it at the time of closure as the control group（group B）.Operation time, the volume of blood loss, and neurologic recovery rate obtained by Japanese Orthopedic Association （JOA） score were compared between group A and B. The ROM and alignment of the cervical spine using Cobb＇s methods and self-assessment were also evaluated. Results： All patients were followed up at least 1 year. The mean postoperative JOA score of group A and B was about 63.01% and 60.83% respectively. There was no significant difference between them （P〉0.05）. However, difference for operation time and the volume of blood loss was obvious（P〈0.05 ）. For group A, the ROM of the cervical spine decreased to 81.6% comparing with the preoperative extent, and that of group B 65.3%. There were neither severe complications nor complaints happened in group A. Conclusiona： This modified cervical laminoplasty is favorable for shorting operation time, decreasing blood loss and serious complications and maintaining cervical curvature, while active cervical extension exercise can be carried out earlier postoperatively.