颈椎后路双开门椎管扩大成形术治疗伴交感神经症状颈椎病的临床疗效研究

Efficacy of double-door laminoplasty in treatment of cervical spondylosis with sympathetic symptoms

背景:临床上常见颈椎病患者合并头晕、头痛、耳鸣、眼花等一类交感神经症状,目前关于合并交感神经症状患者手术治疗的临床研究较少。目的目的:探究和评价颈椎后路椎管扩大成形术治疗伴交感神经症状的颈椎病的临床疗效。方法方法:回顾性分析2011年6月至2017年6月33例伴交感神经症状的颈椎病并接受颈椎后路双开门椎管扩大成形术的33例患者资料。采用改良20分评分法分别在术前、术后1个月及末次随访时对交感神经症状进行评分,同时用JOA颈椎评分对脊髓功能进行评分,计算术后1个月和末次随访时对比术前的改善率及临床效果满意度。结果结果:随访时间为11～76个月,平均(26.2±15.8)个月。术前颈椎JOA评分为13.6±2.5,交感神经症状评分为6.8±4.6,术后1个月JOA评分为14.4±2.9,交感神经症状评分为4.1±3.8,末次随访JOA评分为15.7±6.5,交感神经症状评分为4.2±3.5,与术前比较,术后两次交感神经症状评分下降(P<0.05)。9例患者术后出现了不同程度的颈肩痛;1例患者术后出现脑脊液漏和切口积液,术后给予患者腰大池引流后加压包扎加以抗生素治疗,患者症状明显改善;1例患者术后10 d出现心血管事件,介入治疗后好转。结论结论:颈椎后路椎管扩大成形术可以有效治疗伴交感神经症状的混合型颈椎病,其中交感神经症状可以得到明显缓解和维持。

Background:Cervical spondylosis with sympathetic symptoms including vertigo,headache,tinnitus and giddiness, is usually seen,and there are few clinical studies on laminoplasty for cervical spondylosis patients with sympathetic symptoms. Objective:To investigate the clinical effectiveness of laminoplasty in treatment of cervical spondylosis with sympathetic symptoms.Methods:Retrospective analysis was conducted in 33cervical spondylosis patients with sympathetic symptoms undergoing laminoplasty from June 2011to June 2017.The sympathetic symptoms including vertigo,headache,finnitus,nausea and vomiting,heart throb,hypomnesia and gastroenterological discomfort were scored by modified 20-point system preoperatively, 1month postoperatively and at the final follow-up,and we also analyzed the cervical JOA score simultaneously.The recovery rate and satisfaction were evaluated at 1month postoperatively and the final follow-up.Results:All patients were followed up for 11-76months with the mean as (26.2±15.8)months.The cervical JOA score was significantly higher in the last follow-up (15.7±6.5)than that before the surgery (13.6±2.5)and sympathetic symptoms improved in most patients and the score was significantly improved one month after surgery (4.1±3.8)and at the last follow-up (4.2±3.5)than the initial score (6.8±4.6).There were 9patients who had experienced mild or moderate neck-shoulder pain after surgery.Cerebrospinal fluid leakage and sub- cutaneous effusion occurred in one patient who received lumbar cistern drainage and antibiotics and symptoms improved significantly.One patient suffered from a postoperatively cardio-vascular incident 10days after surgery and recovered by PCI treat- ment.Conclusions:Cervical spondylosis patients with sympathetic symptoms may be managed successfully with laminoplasty with sympathetic symptoms relieved or holded.