单开门椎管扩大椎板成形术保留一侧肌肉韧带复合体对颈后肌肉容积的影响

Effect of open-door laminoplasty together with preservation of the unilateral paraspinal muscle ligament complex on the posterior muscle volume of cervical spine

目的：评价单开门椎管扩大椎板成形术时保留一侧肌肉韧带复合体对颈后肌肉容积的影响。方法：对60例因脊髓型颈椎病行后路单开门椎管扩大椎板成形术的患者保留一侧（右侧）肌肉韧带复合体,其中男性41例,女性19例;年龄34-78岁,平均58.0岁;随访2.5-15个月,平均4.3个月,在术前和末次随访时均行颈椎MRI检查,在横断面MRI片上用Photoshop测量术前、末次随访时C2/3、C3/4、C4/5、C5/6、C6/7椎间盘水平左右两侧颈后肌肉的横截面积,以5个水平的总面积表示颈后肌肉的容积。对术前、末次随访时各个水平的左右侧颈后肌肉面积进行比较,并分别比较术前左侧与右侧总面积、末次随访时左侧与右侧总面积以及术前与末次随访时各单侧总面积的变化,用SPSS16.0对结果进行统计分析。结果：术前各个椎间盘水平左右侧颈后肌肉面积无显著性差异（P〉0.05）,末次随访时C3/4、C4/5、C5/6水平右侧颈后肌肉面积明显大于左侧（P〈0.05）,在C2/3、C6/7水平上左右侧颈后肌肉面积无显著性差异（P〉0.05）。右侧C2/3、C3/4、C4/5、C5/6水平颈后肌肉面积及右侧总面积的变化值（末次随访时-术前）与左侧相对应的变化值有显著性差异（P〈0.05）;在C6/7水平上两者均无显著性差异（P〉0.05）。术前右侧颈后肌肉总面积与左侧比较无显著性差异（P〉0.05）;末次随访时右侧颈后肌肉总面积明显大于左侧（P〈0.05）。结论：单开门椎管扩大椎板成形术保留一侧肌肉韧带复合体减少了对颈后方肌肉的破坏,在一定程度上保持了颈后肌肉的容积。

Objective：To evaluate the effect of open-door laminoplasty together with preservation of the unilateral paraspinal muscle ligament complex on the posterior muscle volume of cervical spine.Method：60 patients experiencing open-door laminoplasty together with preservation of the unilateral（right side） paraspinal muscle ligament complex due to cervical spondylotic myelopathy were reviewed retrospectively.They were 41 males and 19 females with the mean age of 58.0 years（range,34-78 years） and were followed up for an average of 4.3 months.MRI was performed before operation and at final follow-up.The unilateral cervical posterior muscle volume at cross-section plane at each intervertebral level of C2/3,C3/4,C4/5,C5/6 and C6/7 was measured on MRI using Photoshop software and summed the five ipsilateral area values as the muscle volume.The data were analyzed using SPSS 16.0.Result：Before operation,there was no significant side-related difference for muscle area at each level（P〈0.05）.At final follow-up,muscle areas on the right were significantly larger than the countraside at C3/4,C4/5,C5/6（P〈0.05）,but not at C2/3 and C6/7（P〈0.05）.The changes of muscle areas at C2/3,C3/4,C4/5,C5/6 and the sums of the five ipsilateral muscle areas before operation and at final follow-up were greater at right side than those at left side（P〈0.05）,but not at C6/7（P〈0.05）.Before operation,there was no significant side-related difference for the sums of the five muscle areas,but at final follow-up,the sums at right side was significant larger than those at left side（P〈0.05）.Conclusion：Open-door laminoplasty together with preservation of the unilateral paraspianl muscle ligament complex is less invasive to the posterior cervical muscle and maintain the posterior cervical muscle volume to some degree.