双开门椎管扩大成形术治疗颈髓挥鞭样损伤

Double-door laminoplasty for treatment of cervical whiplash injury

目的探讨双开门椎管扩大成形术治疗颈髓挥鞭样损伤的效果。方法回顾性分析2001年1月—2011年10月手术治疗颈髓挥鞭样损伤并获随访的41例患者临床资料，其中男32例，女9例；年龄（51.0±12.0）岁（28～74岁）。致伤原因：交通伤30例，跌倒伤8例，高处坠落伤3例。所有患者均伴有发育性颈椎管狭窄，6例合并有后纵韧带骨化。手术包括后路双开门椎板成形椎管扩大术36例，I期前后联合入路手术5例。根据患者年龄、术前日本骨科协会（Japanese Orthopedic Association，JOA）评分和手术时间进行分组，比较各组疗效。结果手术时间70～180min，平均121.9min；术中出血量30～500ml，平均177.8ml。所有患者均获随访12～110个月，平均59.4个月。术后JOA评分平均14.7分，较术前明显改善（P〈0.01），平均改善率为77.8％。非老年组和老年组术后JOA评分改善率[（79.6±18.8）％：（73.5±22.8）％]和优良率（90％：83％）差异均无统计学意义。JOA评分不同组患者均获得满意疗效，差异无统计学意义，但末次随访时JOA评分组间差异有统计学意义（P〈0.01）。相对于晚期手术组，早期手术组JOA评分改善率[（84.6±13.3）％：（75.4±24.0）％]更为明显，手术效果更好（P〈0.05）。结论在严格把握手术适应证的情况下，双开门椎管扩大术治疗颈髓挥鞭样损伤效果可靠，高龄者也有较好的神经功能恢复，但术前损伤严重或晚期手术者预后较差。

Objective To analyze efficacy of double door laminoplasty for treatment of whiplash injury of the cervical spine. Methods Forty-one cases of cervical whiplash injury treated surgically from January 2001 to October 2011 and available to follow up were analyzed retrospectively. There were 32 males and 9 females with mean age of （51.0±12.0） years （range, 28 to 74 years）. Causes of injury included traffic accidents in 30 cases, fall on the ground in 8, and high fall in 3. All cases were combined with developmental cervical stenosis and six with ossification of the posterior longitudinal ligament. Posterior double-door laminoplasty was operated in 36 cases and one-stage surgery via anterior-posterior approach in 5 cases. Cases were grouped according to their ages, preoperative cervical Japanese Orthopedic Association （JOA） score, and operation time. Results were compared among groups. Results, Operation lasted for 70-180 minutes （mean, 121.9 minutes） and showed blood loss of 30-500 ml （mean, 177.8 ml）. All cases were followed up for 12 to 110 months （mean, 59.4 months）. Overall JOA score averaging 14.7 points improved significantly after operation with mean improvement rate of 77.8% （ P 〈 0.01 ）. Whereas between non-elderly and elderly groups, postoperative JOA improvement rate [ （79.6±18.8）% vs （73.5 ±22.8）% ] and excellent rate （90% vs 83% ） were similar. For cases grouped according to their preoperative JOA score, the results were satisfactoryfor all groups, but the differences were insignificant. Besides, JOA score at the last follow-up differed significantly among groups （P 〈 O. Ol ）. Improvement rate of JOA score was better in early surgery group than in late surgery group [（84.6±13.3）% vs （75.4±24.0）%, P〈0.05]. Conclusions Double door laminoplasty is reliable in treatment of cervical whiplash injury on condition that surgical indications are grasped strictly. Elderly or gravely injured patients can also have considerable recovery of neurological function, but patients with severe injury or late surgery are associated with poor prognosis.