颈后路单开门椎管成形术治疗脊髓型颈椎病

Postenior single open-door laminoplasty for treating cervical spondylotic myelopathy with cervical spinal stenosis

目的:观察颈后路单开门椎管扩大成形术对颈椎管狭窄合并钳夹型脊髓型颈椎病的临床效果和可行性。方法:采用颈后路椎管扩大成形术治疗颈椎管狭窄合并钳夹型脊髓型颈椎病30例,男19例,女11例,常规C3-C7减压,棘突打孔10号线固定在门轴侧侧块关节囊上12例,门轴侧C3、C5、C7侧块螺钉固定悬吊椎板18例,术前和术后通过日本骨科学会JOA评分(17分法)评估临床疗效。结果:30例均获得随访,随访时间6～76个月,平均25个月。按照JOA评分:优8例,良14例,可6例,差2例,优良率73.33%(22/30)。其中3例术后3个月内发生C4或C5神经根麻痹,经保守治疗痊愈。2例在2年内因疗效不佳再行前路手术。结论:颈后路单开门椎管扩大成形术治疗颈椎管狭窄合并钳夹型脊髓型颈椎病是一种简单、有效可行的方法,尤其适应于老年人。

Objective：To evaluate clinical effect and the feasibility of postenior single open-door laminoplasty for treating cervical spondylotic myelopathy with cervical spinal stenosis. Methods： Thirty patients （ 19 males and 11 females） of cervical spondylotic myelopathy with cervical spinal stenosis were treated with single open-door laminoplasty at the level of C3 - C7 routinely. Eighteen cases of 30 underwent posterior lateral mass plate fixation. The clinical outcomes were evaluated according to the score Japanese Orthopedic Association（JOA） before and after the operation. Results：All the patients were followed up for 6 -76 months with an average of 25 months. Eight cases obtained excellent result, 14 good ,6 fair and 2 poor. Good and excellent rate was 73.33% （22/30）. Among them,the nerve root palsy of C4 or C5 was found in 3 cases at 3 months after operation, the plasy recovered after conservative treatment;2 cases were treated with anterior operation because of bad effect. Conclusion： Single open-door laminoplasty through posterior approach for treating pinching cervical spondylotic myelopathy with cervical spinal stenosls is a simple, effective,and feasible method,which beseems elder patients especially.