康复治疗对脊髓型颈椎病患者椎板成形手术效果的影响

The prevention and cure of postoperative neck axial symptoms after open-door laminoplasty for cervical spondylotic myelopathy

目的观察康复治疗对脊髓型颈椎病患者后路单开门椎管扩大椎板成形手术效果的影响。方法选择60例脊髓型颈椎病患者，年龄（61．7±12．0）岁，均行颈后路单开门椎管扩大椎板成形手术，术后平均随访40.7个月。其中30例手术前、后未行康复治疗，作为对照组；另外30例为康复治疗组，于手术前、后进行系统的康复治疗。观察2组患者术后随访时的神经功能恢复情况、颈后肌群横截面积变化、颈部轴性症状的发生率及术后并发症，并进行比较。结果康复治疗组患者伤口术后均一期愈合，无感染等并发症发生；对照组3例患者伤口感染。2组患者术后神经功能恢复情况比较，差异无统计学意义（P〉0．05）；康复治疗组患者术后颈后肌群萎缩率明显小于对照组（P〈0．05）；同时康复治疗组患者术后颈部轴性症状的发生率为23．3％，对照组为60．0％，差异有统计学意义（P〈0．01）。结论手术前、后进行系统的康复训练虽然不能显著提高脊髓型颈椎病椎板成形术后神经功能的恢复，但可以有效防止术后颈后肌群的萎缩，减少轴性症状的发生。

Objective To evaluate the effectiveness of rehabilitative treatment after extended open-door laminoplasty of the cervical spine for cervical spondylotic rnyelopathy. Methods Sixty patients （mean age 61.7 ± 12 years） who had undergone extended open-door laminoplasty of the cervical spine for cervical spondylotie myelopathy were studied for an average of 40.7 months. They are divided into a rehabilitation group and a control group with 30 patients in each. The patients in the rehabilitation group received systematic rehabilitation therapy pre-and post- operation. In both groups, the neurological recovery rate, the cross-sectional areas of the cervical posterior muscles, and the incidence of axial symptoms and post-operative complications were recorded and compared. Results The wounds of patients in the rehabilitation treatment group healed with no complicating infections, but the wounds of three patients in the control group became infected. There was no statistically significant difference in neurological recovery between the two groups. In the rehabilitation treatment group, the rate of atrophy and the cross-sectional areas of the cervical posterior muscles were significantly lower than in the control group. At the same time, the rate of neck axial symptoms was 23% in the rehabilitation group but 60% in the control group, a difference which was statistically significant. Conclusions Although rehabilitation treatment pre-and post-operation may not speed up neurological recovery, it may prevent postoperative atrophy of the cervical extensors and lower the incidence of neck axial symptoms.