保留颈椎后部棘突肌肉韧带复合体的颈椎后路单开门椎管成形术的应用

Application of retaining ligament-muscle complex of cervical posterior spinous process to single open-door laminoplasty

目的探讨保留颈椎后部棘突肌肉韧带复合体的颈椎后路单开门椎管成形术在维持颈椎的稳定性、减少颈椎疾患术后轴性症状发生中的应用价值。方法选择脊髓型颈椎病(CSM)19例,颈椎后纵韧带骨化症(OPLL)16例,随机分为2组,A组共18例接受保留颈椎后部棘突肌肉韧带复合体的颈椎后路单开门椎管成形术,B组共17例接受传统颈椎后路单开门椎管成形术。对两组患者术后1年的JOA评分改善率、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组为(52·0±21·4)%,B组为(52·7±19·8)%,两组差异无统计学意义。A组术后有明显轴性症状者的比例为22·2%,B组为58·5%,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(2·87±2·32)%,B组患者术后颈椎曲度指数丢失(5·51±2·11)%,两组患者手术前后颈椎曲度指数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(7·58±3·65)%,B组患者术后颈椎活动度丢失(5·51±2·11)%,两组差异有统计学意义(P<0·01)。结论保留颈椎后部棘突肌肉韧带复合体对于其发挥维持颈椎生理曲度和颈椎的稳定性、减少术后轴性症状的发生等具有重要的临床意义。

Objective To verify whether the reservation of ligament-muscle complex（LMC）of posterior cervical spine is effective on maintaining the physiological cervical spine alignment and the stability of cervical spine in the treatment of cervical spondylotic myelopathy（CSM） and ossification of posterior longitudinal l igament（OPLL）. Methods 19 patients with CSM and 16 patients with OPLL enrolled in this study were randomly divided into two groups. Subjects in group A（n=18） received single cervical posterior open-door laminoplasty with retained LMC while those in group B（n=17）received traditional open-door laminoplasty. Postoperative improvement rate of Japanese Orthopedics Association（JOA）scores, the degree of axial symptom, ranges of neck motion and cervical curvature indices were recorded and compared. Results The average JOA improvement rate was （52. 0±4-21.40%） for group A and （52. 7±19. 80%） for group B, There was no significant difference in JOA improvement rate between group A and group B[（52. 0±21.4）vs（52.7±19. 8）%]. In group A, 22. 2% of patients had evident axial symptoms compared with 58. 5% in group B（P〈0. 05）. Loss of cervical curvature indices was（2. 87±2.32） % in group A and（5.51±2. 11 ）% in group B,and the difference was statistically significant（P〈0. 01）. Significant difference was also found in loss of ranges of neck motion between group A and group B[（7.58±3.65）% vs（ 5.51±2. 11）%, P〈0. 01]. Postoperative MRI of patients in group A indicated sufficient expansion of the spinal cord. Conclusion Retaining LMC of cervical posterior spinous process has important clinical significance for maintaining cervical lordosis and its stability as well as reducing the incidence of postoperative axial symptoms.