改良单开门椎板成形术治疗多节段脊髓型颈椎病

Modified open door laminoplasty for treating multi-segmental cervical spondylotic myelopathy

目的评价改良单开门椎板成形术治疗多节段脊髓型颈椎病的疗效。方法 2003年6月~2008年6月,采用改良单开门椎板成形术治疗多节段脊髓型颈椎病38例（A组）,与同期传统单开门手术治疗的42例（B组）进行疗效分析比较,记录轴性症状、JOA评分及颈椎总活动度。结果 A组患者获随访13~54月,平均27.4月,B组患者获随访12~47月,平均25.7月。A组术前JOA评分（8.31±2.21）分,术后（14.00±1.90）分,改善率68.32%;B组术前JOA评分（8.00±2.41）分,术后（13.90±2.15）分,改善率67.63%,两组无明显差别。A组术后轴性症状发生率26.32%,B组术后轴性症状发生率50.00%,两组差异明显。A组颈椎总活动度为术前79.84%,B组颈椎总活动度为术前63.95%,两组差异明显。结论改良单开门椎板成形术是一种安全有效的外科技术,能够有效减轻术后轴性症状,更大限度保留颈椎活动度。

Aim To investigate the clinical efficacy of modified open door laminoplasty in treating multi-segmental cervical spondylotic myelopathy.Methods From June 2003 to June 2008,38 cases with multi-segmental cervical spondylotic myelopathy were treated by modified open door laminoplasty,and 42 cases were treated by traditional expansive open door laminoplasty.They were analyzed retrospectively using the Japanese Orthopetic Association（JOA） scale,Axial symptoms（AS）,ranges of motion（ROM） of cervical vertebra.Results Patients of group A were followed up 13 to 54 months（average 27.4 month）.Patients of group B were followed up 12 to 47 months（average 25.7 months）.The average preoperative JOA score of group A was（8.31±2.21） and postoperative JOA score was（14.00±1.90）,with an average improvement rate of 68.32%.The average preoperative JOA score of group B was（8.00±2.41） and postoperative JOA score was（13.90±2.15）,with an average improvement rate of 67.63%（P0.05）.The incidence of postoperative AS of group A was 26.32%,and group B was 50.00%（P0.05）.Postoperative ROM of group A was 79.84%,and group B was 63.95%（P0.05）.Conclusion Modified open door laminoplasty is a safe and effective surgical technique.It can reduce the incidence of postoperative AS effectively,and keep the ROM of cervical vertebra.