两种颈椎椎管扩大成形术治疗多节段颈椎退行性疾病的疗效比较

Comparison of two kinds of open-door cervical expansive laminoplasty for multilevel cervical degenerative diseases

目的：探讨单开门、双开门两种椎管扩大成形术治疗多节段颈椎退行性疾病的临床疗效及并发症发生情况。方法回顾性分析2008年1月至2013年1月收治的73例行颈椎椎管扩大成形手术患者的临床资料，其中单开门组32例、双开门组41例。比较两组患者手术时间、术中出血量、日本骨科学会（JOA）评分改善率及术后并发症发生情况。结果73例患者均获随访，平均随访时间34.8个月（24～52个月），随访2年后失访3例。单开门组在手术时间、术中出血量方面优于双开门组（P＜0.05）。单开门组和双开门组JOA评分改善率分别为66%±18%和58%±27%，两组比较，差异无统计学意义（P＞0.05）。单开门组术后C5神经根麻痹、脑脊液漏、切口感染发生率（6%、3%、3%）低于双开门组（7%、10%、5%），但两组比较，差异无统计学意义（P ＞0.05）；单开门组肩颈椎轴性症状发生率（31%）高于双开门组（12%），两组比较，差异有统计学意义（P ＜0.05）。结论两种术式治疗多节段颈椎退行性疾病的临床疗效相似；单开门术式具有手术时间短、术中出血量少等优势，而双开门术式肩颈轴性症状发生率则相对较低。

Objective To investigate the clinical effects and surgical complications of unilateral and bilateral open-door cervical expansive laminoplasty for multilevel cervical degenerative diseases. Methods A retrospective study was carried on 73 patients with multilevel cervical degenerative disease treated by cervical expansive laminoplasty from January 2008 to January 2013. According to different surgical procedures, they were divided into 2 groups, unilateral open-door group （32 patients） and bilateral open-door group （41 patients）. The operation time, intraoperative estimate blood loss, Japanese Orthopaedic Association （JOA） scoring improvement rate and＆nbsp;postoperative complications were compared between two groups. Results All patients were followed up with an average period of 34.8 months （range, 24 to 52 months）, and three patients were lost to follow up after two years later. Operation time and intraoperative estimate blood loss in unilateral open-door group were less than those in bilateral open-door group （P 0.05）. In unilateral open-door group, incidence of C5 nerve root palsy, cerebrospinal fluid leakage or surgical site infection （6%, 3%, 3%） was lower than that in bilateral open-door group （7%, 10%, 5%） respectively, but the differences between two groups had no statistical significance （P 〉0.05）; Incidence of axial symptoms in unilateral open-door group （31%） was higher compared with that in bilateral open-door group （12%）, there was statistical difference between two groups （P 〈0.05）. Conclusions Both unilateral and bilateral open-door cervical expansive laminoplasty are effective for the treatment of multilevel cervical degenerative diseases, in which the former has shorter operation time and less intraoperative estimate blood loss, while the latter has lower incidence of axial symptoms.