颈椎后路单、双开门椎管成形术治疗多节段脊髓型颈椎病的临床比较

Multilevel cervical spondylotic myelopathy with single、double door laminoplasty:a clinical comparison

目的分析比较颈椎后路单、双开门椎管成形术治疗多节段脊髓型颈椎病的临床效果。方法回顾2003-09-2009-06收治的50例多节段脊髓型颈椎病患者,其中28例行颈椎后路单开门椎管成形术,作为A组;22例行颈椎后路双开门椎管成形术,作为B组。对两组患者术前及术后2年的JOA评分改善率、轴性症状严重程度、颈椎活动度进行评估比较。结果 JOA评分改善率A组(52.0±21.4)%,B组为(52.7±19.8)%,两组差异无统计学意义(P=0.970>0.05)。A组术后有明显轴性症状患者的比例为42.9%,B组为36.4%,组间比较差异无统计学意义(P=0.642>0.05)。颈椎活动度A组平均丢失3.9°,B组平均丢失3.6°,两组差异无统计学意义(P=0.492>0.05)。结论颈椎后路双开门椎管成形术比单开门椎管成形术的轴性症状发生率及颈椎活动丢失率更低。但两者间的差异无统计学意义。术者可以根据不同的适应证及术者自身的熟练程度来采用不同开门方法。

Objective Clinical effect of multilevel cervical spondylotic myelopathy with cervical posterior single or double door laminoplasty were analyzed and compared.Methods From september 2003 to June 2009,28 patients with cervical spondylotic myelopathy（CSM）undergone single door laminoplasty（Group A）,22 patients with CSM undergone double door laminoplasty（Group B）.Postoperative improvement rate of Japanese Orthopedics Association（JOA）scores,the degree of axial symptom and ranges of neck motion were recorded and compared.Result The average JOA improvement rate were（52.0±21.4）% for group A and（52.7±19.8）% for group B,There was no significant difference in JOA improvement rate.In group A,42.9% of patients had evident axial symptoms compared with 36.4% in group B（P=0.6420.05）.Significant difference was not found in loss of ranges of neck motion between group A and group B（3.9°vs 3.6°,P=0.4920.05）.Conclusions Double door laminoplasty than single door laminoplasty has low axial symptom incidence and cervical activity loss rate.But the difference was not statistically significant between the two groups.Operators according to proficiency in different operation methods and clinical indications choose the different open door laminoplasty.