保留颈后方韧带复合体单开门椎管扩大成形术后其颈椎生理曲度及活动范围的中远期随访

The mid-long-term influence of open-door laminoplasty with reconstruction of the posterior cervical ligamentous complex on cervical physiological curvature and range of motion

目的：观察保留颈后方韧带复合体重建伸肌附着点单开门椎管扩大成形术治疗脊髓型颈椎病对颈椎生理曲度、活动范围的中远期影响。方法：2005年1月～2008年1月采用保留颈后方韧带复合体联合重建伸肌附着点单开门椎管扩大成形术治疗脊髓型颈椎病20例患者，其中男性12例，女性8例，年龄37～68岁，平均52岁。比较患者手术前后JOA评分、颈椎生理曲度（C2～C7 Cobb角）及活动范围（ROM）。结果：20例患者均获随访，随访5～8年，平均7年。JOA评分术前为7～13分，平均9.5分；末次随访时为9~17分，平均14.0分，与术前比较明显改善（P＜0.05），改善率为52%。C5椎管/椎体比率术前为0.56～0.8，平均0.67；末次随访时为0.86～1.42，平均1.21，与术前比较椎管矢状径扩大明显（P＜0.05）。术前C2～C7 Cobb角中立位为0°～16°，平均7.8°；末次随访时为4°～16°，平均8.6°，与术前比较差异有显著性（P＜0.05），过伸位31°（24°～38°），过屈位-2.7°（-11°～0°）。术后颈椎前凸无明显减少，所有随访患者无一例出现后凸畸形。但术后颈椎活动范围较术前减少，平均ROM为28°，与术前（42.1°）比较差异有显著性（P＜0.05），过伸位26°（21°～29°），与术前（28°）比较差异无显著性（P＞0.05），过屈位7°（5.5°～19°），与术前（16°）比较差异有显著性（P＜0.05）。回植的棘突与掀起的椎板骨性融合，回植的C2棘突附着点及椎板的门轴侧均骨性愈合，未出现再次关门情况，椎管形态维持良好。结论：保留颈后方韧带复合体重建伸肌附着点单开门椎管扩大成形术治疗脊髓型颈椎病对维持生理曲度具有良好效果，但颈椎活动范围有部分丢失。

Objectives： To study the mid-long-term influence of open-door laminoplasty with reconstruction of the posterior cervical ligamentous complex on cervical physiological curvature and range of motion． Methods： From January 2005 to January 2008, 20 patients undergoing open-door laminoplasty with reconstruction of the posterior cervical ligamentous complex were reviewed retrospectively, the series consisted of 12 males and 8 females, aged 37-68 years（average, 52 years）． The JOA score, alignment of the cervical spine and the ROM of the cervical spine were analyzed before and after operation respectively． Results： 20 patients were followed-up for a mean time of 7 years（range, 5-8 years）. The mean JOA score was 9.5（7-13） before operation. At final follow up, the mean JOA score was 14.0（9-17） and the recovery rate was 52%, which showed significant improvement（P〈0.05）, compared with the preoperative ones. The mean C5 vertebral canal/body ratio of X-ray measurements with the neutral position was 0.67（0.56-0.8） before operation. Postoperative sagittal diameter of canal expanded significantly, at neutral position at final follow-up was 1.21（0.86-1.42）（P〈0.05）. The mean C2-C7 Cobb angle at neutral position at final follow-up was 8.6（4-16）, which showed significant difference（P〈0.05） compared with the preoperative（0-16°, mean 7.8°）; 26 degrees（21-29 degrees） for extension, no significant difference（P＞0.05） compared with the preoperative（29°）; and 7 degrees（5.5-19 degrees） for flexion, which showed significant difference（P〈0.05） compared with the preoperative（-15°）. The mean ROM was 42.1° before operation, and it was 28° after operation. The postoperative extension position averaged 26°（21°-29°）, no significant difference compared with the preoperative（28°, P＞0.05）, and flexion position averaged 7°（5.5°-19°）, showing significant difference compared with the preoperative（16°, P＜0.05）. Replanted spinous process and the float laminae got bony fusion. No door re-closure was observed, and good vertebral canal maintaining was maintained. Conclusions： After open-door laminoplasty, the procedure of reconstruction of the posterior cervical ligamentous complex and the insertion of extensor to treat CSM will be helpful on maintaining the cervical physiological curvature, but it reduces the range of motion through the mid-long-term observation.