C3～C6与C3～C7后路椎板切除术后疗效及轴性疼痛的比较

Comparison of Clinical Efficacy and Axial Pain after Posterior Laminectomy between C3- C6 and C3- C7 Segments

目的 研究C3 ～ C6与C3 ～ C7节段颈椎后路椎板切除减压、融合、侧块螺钉内固定术后临床疗效及轴性疼痛的差异.方法 对笔者医院2011年5月～2013年5月期间48例接受C3 ～ C6（A组）与C3 ～ C7（B组）节段后路椎板切除减压、融合、钉棒内固定术的患者进行回顾性分析,随访时间至少1年.对两组患者术前及术后按照日本骨科学会（Japanese Orthopaedic Association,JOA）脊髓功能评分,颈椎X线片颈椎曲度角度（Cobb＇s角）进行评估.分析两组患者术后轴性症状（axial symptoms,AS）的发生率,并按照视觉模拟评分（visual analogue scale,VAS）对两组病例术后随访各时段轴性症状（axial symptoms,AS）进行比较,并分析其完全缓解所需时间.结果 两组病例术前及术后JOA评分及颈椎曲度角度（Cobb＇s）变化无统计学差异（P＞0.05）;A组轴性疼痛（AS）的发生率为25.0％（6/24）,B组为41.6％（10/24）,两者比较有统计学差异（P＜0.05）;A组术后轴性疼痛VAS 2.8±0.9分,B组为5.1±1.1分,两者比较有统计学差异（P＜0.05）;轴性症状缓解时间A组为98.3±10.7天,B组为181.8±9.2天,两者比较有统计学差异（P＜0.05）.结论 与传统C3～C7颈后路减压手术相比,保留C7棘突、椎板及其后方附着颈后肌群并不影响脊髓功能及颈椎曲度的改变,且可以减轻术后轴性症状（AS）的发生率及程度,并减少缓解所需时间,提高患者生活质量.

Objective To study the difference of clinical efficacy and axial pain of the posterior cervical vertebral decompression,fusion and lateral mass screw fixation between C3-C6 and C3-C7 segments.Methods A total of 48 patients from May 2011 to May 2013 in our hospital,who underwent C3-C6 （group A） and C3-C7 （group B） posterior decompression with laminectomy,fusion and lateral mass screw fixation,were analysed retrospectively,and the follow-up was at least 1year.We evaluated the Japanese Orthopaedic Association （JOA） score and cervical curvature Angle （Cobb＇s） of the X-ray before and after operation,and studied the incidence of postoperative Axial Symptoms （AS）,and the axial pain according to visual analogue scale （VAS） score,and also analyzed the time needed for pain relief.Results The changes of JOA score and cervical curvature angle （Cobb＇s） of the two groups had no significant statistical difference （P 〉 0.05）.The incidences of axial pain （AS） in group A and group B were 25.0% （6/24） and 41.6% （10/24）,respectively （P 〈 0.05）.The VAS of postoperative axial pain in group A and group B were 2.8 ± 0.9 and 5.1 ± 1.1,respectively （P 〈0.05）.The time needed for axialpain relief of group A and group B were 98.3 ± 10.7days and 181.8 ± 9.2days respectively （P 〈 0.05）.Conclusion Compared with traditional posterior cervical decompression surgery,keep the spinous process of C7,vertebral plate and rear adherent neck muscles does not influence the spinal cord function and the change of cervical curvature,and can reduce the incidence and degree of postoperative axial symptoms,and also reduce the time needed for pain relief,thus,improve the life quality of the patients.