保留颈后方韧带复合体对颈椎后路单开门椎板成形术椎板开门角度的影响

Effects of reserving of the posterior cervical ligamentous complex on the open-angle of lamina in the posterior cervical single open-door laminoplasty

目的探讨保留颈后方韧带复合体对术后椎板开门角度及神经功能改善率产生的影响。方法对28例脊髓型颈椎病患者采用后路单开门颈椎椎板成形术。根据不同治疗术式分为两组：17例采用不保留颈后方韧带复合体术式为A组,11例采用保留颈后方韧带复合体单开门术式为B组。通过术后2周及末次随访时（≥10个月）CT影像学资料测得椎板开门角;同时评定神经功能改善情况。结果术后2周椎板开门角：A组为38.0°～44.0°（40.3°±1.0°）,B组为37.2°～42.5°（40.7°±0.7°）,差异无统计学意义（P〉0.05）。末次随访时椎板开门角：A组为34.8°～45.0°（39.0°±3.1°）,B组为34.0°～36.5°（35.7°±0.4°）,差异有统计学意义（P〈0.05）。两组术后2周及末次随访时神经功能改善率：A组为27.8%～37.0%（32.4%±4.3%）及53.3%～68.0%（59.7%±5.6%）,B组为26.3%～38.2%（32.1%±5.0%）及44.4%～67.0%（58.5%±5.9%）,两组比较差异均无统计学意义（P〉0.05）。两种术式术后2周及末次随访时再关门率均为0。结论保留颈后方韧带复合体单开门术式的椎板开门角度小于不保留颈后方韧带复合体术式。两组的神经功能改善率无差异。

Objective To study the effects of reserving the posterior cervical ligamentous complex on the open-door angle of lamina and the improvement ratio of neurological function in the posterior cervical single open-door laminoplasty. Methods All 28 cases were treated with single open-door laminoplasty. According to surgical procedure,17 cases without reserving posterior cervical ligamentous complex were classified to group A and the remnant 11 cases of reserving posterior cervical ligamentous complex were classified to group B. The open-door angle was measured on CT films at 2 weeks postoperatively and the last follow-up（ at least 10 months）,and the improvement of neurological function was also assessed at the same time. Results The open-angle of lamina in group A was 38. 0° ～ 44. 0°（ 40. 3° ± 1. 0°） and 37. 2° ～ 42. 5°（ 40. 7° ± 0. 7°） in group B at 2 weeks postoperatively,there was no significant difference between them（ P〉0. 05）. However,it had significant difference at the last follow-up（ P〈0. 05）,which was 34. 8° ～ 45. 0°（ 39. 0° ± 3. 1°） in group A and 34. 0° ～ 36. 5°（ 35. 7° ± 0. 4°） in group B. The neurological function in group A was 27. 8% ～ 37. 0%（ 32. 4% ± 4. 3%） at 2 weeks postoperatively. It increased to 53. 3% ～68. 0%（ 59. 7% ± 5. 6%） at the last follow-up（ P〉0. 05）. And in group B,it increased from 26. 3% ～ 38. 2%（ 32. 1% ± 5. 0%） at 2 weeks postoperatively to 44. 4% ～ 67. 0%（ 58. 5% ± 5. 9%） at the last follow-up（ P〈0. 05）. None cases reclosed the opened laminae during follow-up. Conclusions The open-angle of lamina in patients treated by the open-door laminoplasty with reserving the posterior cervical ligamentous complex is smaller than the patients without reserving the posterior cervical ligamentous complex. However,the improvement ratio of neurological function has no significant difference.