影响单开门椎管扩大成形术治疗颈椎病疗效的术后相关因素分析

Postoperative factors affecting neurological recovery after laminoplasty for cervical spondylotic myelopathy

目的探讨单开门椎管扩大成形术治疗多节段脊髓型颈椎病术后因素对手术效果的影响。方法回顾性分析2001年5月至2006年12月接受单开门椎管扩大成形术治疗的多节段脊髓型颈椎病患者。选取JOA改善率〉75％（A组38例）和〈25％的病例（B组32例）进行分析。对两组患者年龄、性别、病程、术前JOA评分、术前Pavlov比率、术前颈椎活动度、术前颈椎曲度指数、脊髓受压节段数、随访时间等可能影响术后JOA改善率的术前参数行统计学分析，两组只在年龄和术前JOA评分上差异有统计学意义。去除两组中年龄〉60岁的病例以及JOA评分〈6分的病例。A组剩余24例（A1组），B组18例（B1组）。再次对A1组和B1组行以上统计学分析，两组各项参数差异均无统计学意义。对A1和B1两组术后颈椎活动范围及其改变率、术后颈椎曲度指数及其改变率、术后Pavlov比率及椎管扩大率等六项参数进行成组设计t检验，并与JOA改善率进行相关性分析。结果上述六项参数中除两组术后颈椎活动范围差异无统计学意义（P〉0．05），其余五项参数差异均有统计学意义（P〈0．05）。A1组中除术后颈椎活动范围与JOA改善率无相关性，其余指标均与JOA改善率有相关性；B1组中除术后颈椎活动范围及其改变率与JOA改善率无相关性，其余各指标均与JOA改善率有相关性。结论术后减小颈椎活动范围、维持颈椎前凸及尽量扩大椎管直径有利于神经功能的恢复。

Objective To elucidate possible postoperative factors affecting neurological recovery after cervical expansive open-door laminoplasty in treatment of patients with multilevel cervical spondylotic myelopathy. Methods This study involved the patients with multilevel cervical spondylotie myelopathy who underwent expansive open-door laminoplasty between May 2001 and December 2006. They were classified into two groups according to the degree of neurological recovery： an excellent recovery group （group A）, the recovery rates greater than 75%, and a poor recovery group （group B）, the recovery rates lower than 25%. Comparisons of various preoperative clinical and imaging parameters such as patient＇s age, gender, duration between symptom onset and surgery, follow-up time, preoperative JOA score, preoperative range of motion （ROM）, preoperative cervical curvature index（CCI）, preoperative Pavlov ratio, segments of myelopathy and so on, revealed that the mean age and mean preoperative JOA scores were significantly different. The cases with the age older than 60 years and preoperative JOA scores less than 6 were excluded. Therefore, group A remained 24 cases （group A1 ） and group B 18 cases （group B1）. The same analyses were repeated between group A1 and group B1. There was no significant difference between two groups among the above mentioned parameters. Postoperative ROM and its reduction rate, postoperative CCI and its reduction rate, Pavlov ratio and its increasing rate were analyzed by t test, and the relationship between these six parameters and improving rate of JOA scores were also analyzed. Results Except postoperative ROM, other five indexes were statistical differences between A1 and B1 groups. Except postoperative ROM in group A1 and postoperative ROM and its reduction rate in group B1, other indexes had statistical correlation with improving rate of postoperative JOA scores. Conclusion Modulating postoperative ROM, maintaining cervical lordosis and achieving sufficient canal diameter may improve neurological recovery in selected patients.