颈后路三种手术方法对颈椎曲度及轴性症状的长期影响

Long-term clinical significance of three posterior operative ways on curvature index and axial symptom for multilevel cervical spondylotic myelopathy

[目的]探讨颈椎后路三种手术方法对术后颈椎曲度及轴性症状(axial symptom,AS)产生的长期影响及临床意义。[方法]自2004年5月～2008年1月,回顾性分析98例多阶段脊髓型颈椎病(cervical spondylotic myelop-athy,CMS)患者。A组30例多节段脊髓型颈椎病患者行颈后路全椎板减压手术。其中,男22例,女8例;年龄42～75岁,平均57.1岁。B组36例多节段脊髓型颈椎病患者行颈后路单开门椎管成形手术。其中,男25例,女11例;年龄47～68岁,平均56.6岁。C组32例多节段脊髓型颈椎病患者行颈后路椎板减压侧块螺钉内固定术。其中,男23例,女9例;年龄40～72岁,平均54.4岁。所有患者术前及术后均行颈椎X线检查,对三组患者手术前后的JOA评分、颈椎曲度指数的丢失程度(curvature index,C I)及轴性症状的严重程度进行比较评估。[结果]随访时间24～48个月,平均34个月。JOA评分恢复率,A组患者为(60.1±17.2)%,B组患者为(59.6±21.3)%,C组患者为(62.3±15.8)%,三组差异无统计学意义。A组患者术后颈椎曲度丢失指数为(3.5±2.5)%,B组患者为(3.2±2.6)%,C组为(2.2±1.3)%,三组患者手术前后颈椎曲度的变化差异有统计学意义。A组术后有明显轴性症状患者的比例为43.3%,B组为30.6%,C组为15.6%,三组比较差异有统计学意义(P<0.05)。[结论]颈后路椎板减压术应用侧块螺钉内固定与病人术后恢复程度无明显关联。侧块螺钉内固定能有效防止术后颈椎曲度丢失,并且较少术后轴性症状的发生。

[Objective]To explore the long-term clinical significance of three posterior operative procedures on JOA scores,curvature index and axial symptoms for multilevel cervical spondylotic myelopathy.[Methods]From May 2004 to January 2008,98 patients with multilevel cervical spondylotic myelopathy treated in our hospital were reviewed in this study.Of them,30 patients underwent traditional laminectomy in group A,which consisted of 22 male and 8 female patients.The mean age was 57.1 years（range,42～75）.Thirty-six patients received open-door laminoplasty in group B,which consisted of 25 male and 11 female patients.The mean age was 56.6 years（range,47～68）.Thirty-two patients underwent laminectomy and lateral mass screw fixation in group C,which consisted of 23 male and 9 female patients.The mean age was 54.4 years（range,40～72）.All patients underwent X-ray examination,and the recovery rate was calculated using pre-and postoperative JOA scores for each patient.Postoperative cervical curvature index and axial symptoms were also measured and compared.[Results]All patients were followed up for 24～48 months（average,34 months）.The average JOA recovery rate was（60.1±17.2）% for group A,（59.6±21.3）% for group B and（62.3±15.8）% for group C.There was no significant difference in JOA recovery rate between the three groups.Loss of cervical curvature index was（3.5±2.5）% in group A,（3.2±2.6）% in group B and（2.2±1.3）% in group C.The difference was significant in loss of cervical curvature indices between the three groups.The rate of evident axial symptoms was 43.3% in group A,30.6% in group B and 15.6% in group C,and the difference was statistically significant（P 0.05）.[Conclusion]The application of lateral mass screw fixation has a good clinical outcome and a preventive effect on the development of postoperative axial symptoms.It is also a reliable method to maintain the cervical alignment.