颈后路椎管成形术联合C_(4—5)椎间孔扩大术治疗多节段颈椎病疗效观察

Effect observation of cervical laminoplasty with prophylactic C_4/ C_5 foraminotomy in the treatment of multilevel myelopathy

目的观察颈后路椎管成形术联合C4—5椎间孔扩大术治疗多节段颈椎病的疗效。方法将142例多节段脊髓型颈椎病患者分为2组:A组67例行椎管成形术联合椎间孔扩大术,B组75例行单纯椎管成形术。观察2组神经功能恢复情况,轴性症状、颈椎曲度及稳定性的变化,比较C5神经根麻痹发生率。结果手术均顺利完成,未出现脊髓受损程度加重等情况发生。A组手术时间明显长于B组(P<0.05)。术后2组患者在神经功能恢复(JOA评分)、轴性症状(VAS评分)、颈椎曲度及颈椎活动度方面比较差异均无统计学意义(P均>0.05)。A组出现C5神经根麻痹1例(2%),B组出现7例(9%),2组比较差异有统计学意义(P<0.05)。结论颈后路椎管扩大成形术中,对C4—5椎间孔进行适当扩大可降低C5神经根麻痹的发生率,且不会对颈椎曲度、稳定性及术后轴性症状造成影响。

Objective It is to observe the curative effect of cervical laminoplasty with prophylactic C4/C5 foraminotomy on multilevel myelopathy.Methods 142 patients with multilevel myelopathy were divided into 2 groups：67 cases in group A accepted the procedure of cervical laminoplasty with prophylactic C4/C5 foraminotomy,and 75 patients in group B underwent open-door laminoplasty without prophylactic foraminotomy.After surgery,the rates of C5 palsy between the two groups were compared,and the changes of recovery of nerve function,axial symptom,cervical curvature and stability were observed in both groups.Results All the operations were completed successfully and no further injury of spinal cord was found.The operation time in group A was longer than that in group B （P 〈 0.05）.There was no significant difference in recovery of nerve function （JOA）,axial symptom（VAS）,cervical curvature and stability （P 〉 0.05）.The two groups were demographically similar,except for the operation time.The incidences of C5 palsy were 1.5% and 9.3% in groups A and B respectively,compared with each other,the difference was significant（P 〈 0.05）.Conclusion Prophylactic C4/C5 foraminotomy was effective in preventing postoperative C5 palsy and did not adversely affect the radiological and clinical outcomes of laminoplasty.Therefore,we conclude that this approach is an effective and desirable procedure for preventing postoperative C5 palsy.