单开门椎管成形术不同椎板开门角度治疗多节段脊髓型颈椎病

Explorations to the outcome of different angles of open-door expansive laminoplasty in multi-segmental cervical spondylotic myelopathy

目的 探讨微型钢板固定法单开门椎管成形术不同椎板开门角度治疗多节段脊髓型颈椎病的临床疗效.方法 分析接受微型钢板固定法单开门椎管成形术治疗的99例多节段脊髓型颈椎病患者临床资料.依据术后CT片上测量的椎板开门角度以30°为界将患者分为两组,A组61例：开门角度15°- 30°,B组38例：开门角度＞30°.两组患者术前一般资料比较差异无统计学意义,具有可比性.记录两组患者手术时间、术中出血量、术后第6个月JOA评分、颈椎曲度（C2-C7夹角）、C5神经根麻痹症状发生率.结果 所有患者获得随访,随访时间12-45个月（平均21.27个月）.所有切口均一期愈合.所有患者术后均未出现“再关门”现象.手术时间：A组（110.13 ±13.47） min,B组（109.16±12.79） min,差异无统计学意义（P＞0.05）;术中出血量：A组（150.29 ±31.64） ml,B组（152.07 ±31.37） ml,差异无统计学意义（P＞0.05）;术后第6个月两组患者JOA评分比较差异无统计学意义（P＞0.05）;术后第6个月两组患者颈椎曲度（C2- C7夹角）比较差异无统计学意义（P＞0.05）;C5神经根麻痹症状发生率A组为1.64％（1例）,B组为7.89％（3例）,差异有统计学意义（P＜0.05）.结论 采用微型钢板固定法单开门椎管成形术治疗多节段脊髓型颈椎病开门角度在15°-30°时比开门角度在30°以上能获得更好的临床疗效.

Objective To explore the outcome of different angles of open-door expansive laminoplasty in multi-segmental cervical spondylotic myelopathy.Methods We studied 99 patients presented with multi-segmental cervical spondylotic myelopathy.All patients were treated with open-door expansive laminoplasty by microplate.According to different opening angles which were measured by CT scan after operation,the patients were divided into group A （15°-30°,61 patients） and group B （〉 30°,38 patients）.There were no significant difference of the general situations between patients from the two groups before taking treatments.Record the operation time,the mean intraoperative blood loss and JOA score,cervical curvature,incidence rates of C5 nerve root palsy six months after operation.Results All patients were followed up for an average duration of 21.27 months （range 12-45 months）.All incisions were healed by first intention.No patients suffered ＂re-close of door＂.The operation time was （11O.13 ± 13.47）,（109.16 ± 12.79） minutes minutes in group A,B respectively,and there are no significant difference （P 〉0.05）.The mean volume of bleeding was （150.29 ±31.64） ml,（152.07 ±31.37） ml in group A,B respectively,and there are no significant difference （P 〉 0.05）.There were no significant difference when compared the JOA scores （P 〉 0.05） and Cervical curvature （C2-C7） （P 〉 0.05） 6 months after operations of the patients from the two groups.The incidence of C5 nerve root palsy was 1.64%,7.89% in group A,B respectively,and there were significant difference （P 〈 0.05）.Conclusion The opening angle between 15° and 30° of open-door expansive laminoplasty by microplate can achieve a better outcome when compared witb angle above 30°.