颈椎曲度及椎间高度变化对颈后路减压术后疗效的影响

Effect of cervical curvature and intervertebral height on the surgical outcome of posterior decom-pression

目的探讨颈椎曲度及椎间高度的变化对颈后路减压术治疗多节段脊髓型颈椎病疗效的影响。方法选取2006年7月至2009年1月行手术治疗的多节段脊髓型颈椎病（≥3个节段）患者50例为研究对象，分为侧块螺钉内固定组（侧块组）26例，单开门组24例，回顾性分析颈椎曲度和椎间高度的变化对术后疗效[日本骨科协会评分（Japanese Orthopaedic Association Scores，JOA）改善率和颈部疼痛视觉模拟评分（visual analog scale，VAS）]的影响。结果所有患者均获得8个月一4年随访，平均（24．0±5．5）个月。侧块组术前颈椎曲度与术后3天比较，差异有统计学意义；单开门组同期比较，差异无统计学意义。侧块组术后3天颈椎曲度与术后6个月、术后3年比较，差异无统计学意义；单开门组同期比较，差异有统计学意义。侧块组术后3年JOA评分改善率优于单开门组，差异有统计学意义。进一步以颈椎曲度及椎间高度丢失程度为标准进行分组分析显示，颈椎曲度和椎间高度低度丢失组术后3年JOA评分改善率及颈部VAS评分均优于高度丢失组，差异有统计学意义。结论颈椎后路全椎板减压侧块螺钉内固定能够改善术后颈椎曲度及保持术后椎间高度，能有效地降低轴性症状的严重程度及提高中期JOA评分改善率。

Objective To analyze the effect of cervical curvature and intervertebral height on the surgical outcome of posterior decompression in patients with multi-level cervical spondylotic myelopathy. Method A total of 50 patients with multi-segment cervical spondylotic myelopathy ≥ segments）, treated with posterior decompression from June 2006 to January 2009 were retrospectively analyzed. Twenty six pa- tients underwent cervical omni-posterior decompression and lateral mass screw internal fixation （group A）; 24 patients underwent expansive open-door laminoplasty （group B）. The effects of changing of cervical curvature and intervertebral height on JOA score and VAS score were analyzed. Results All patients were followed up for 8 months to 4 years （average, 24 ±5.5 months）. There were statistical differences of cervical curvature angles between preoperative and 3 days postoperatively in group A, while no statistical differences in group B. There were no statistical differences of cervical curvature angles between 3 days, 6 months and 3 years postoperatively in group A, while there were differences in group B. After further analysis of the loss of cer- vical curvature and intervertebral height, the result showed that JOA score and VAS score in the low-loss group were better than those in the high-loss group. Conclusion Lateral mass screw internal fixation after cervical omni-posterior decompression had many advantages such as reducing the change of cervical curva- ture, the loss of intervertebral height and incidence of cervical axial symptoms.