保留C_(2、3)棘突肌肉附着点的改良颈椎管扩大成形术

Modified expansive open-door cervical laminoplasty preserving muscle attachment points of C_2 and C_3 spinous process

[目的]观察保留C_（2、3）棘突肌肉止点的改良颈后路椎管扩大成型术的临床疗效,探讨保留C_2、C_3棘突肌肉止点对预防颈椎前曲角度丢失、降低轴性症状发生率等并发症方面的临床效果。[方法]2006年1月~2013年10月,对145例C_（4~7）水平狭窄的多节段脊髓型颈椎病患者,按照随机数字表法分组,72例采用C_3椎板下半部切除、T1椎板上半部切除、C4~7单开门椎管扩大成形术（改良组）;73例采用C3~7单开门椎管扩大成形术（传统组）。记录两组手术时间、术中出血量、术后引流量;手术前、后按日本矫形外科学会（JOA）评分标准评定神经功能,并计算改善率;记录颈椎曲度和颈肩部疼痛的VAS评分,并进行统计学分析。[结果]随访时间12~47个月,平均23个月。改良组手术时间少于传统组,出血量及引流量与传统组无显著差异。术后12个月随访,改良组和传统组JOA评分、改善率差异无统计学意义;颈椎曲度方面：末次随访时改良组与传统组对比差异有统计学意义,改良组较传统组能更好的维持颈椎前曲;改良组VAS评分明显低于传统组,两组差异有统计学意义。并发症方面：两组术后均未发生脑脊液漏,无切口感染,无1例出现椎板关门。随访期间无内固定松动、脱出、断裂等并发症发生。[结论]保留C_（2、3）棘突肌肉止点的改良颈后路椎管扩大成型术能够在保护颈半棘肌等颈后部伸肌群的情况下实现5个椎板长度的椎管减压,缩短手术时间,获得与传统术式相同的减压效果,并能更好的维持颈椎前凸角度,减少颈肩部疼痛的发生率。

[Objective] To observe the clinical effect of modified expansive open- door cervical laminoplasty preserving muscle attachment points of C_2 and C_3 spinous process,and to investigate this preserving whether or not could prevent the loss of anterior cervical curve and reduce the incidence of axial symptoms. [Methods] From January 2006 to October 2013,145 cases of spondylotic spondylosis patients with stenosis at the C_（4 ~ 7）multilevel cervical were divided into 2 groups according to the random number table method,72 cases were treated with lower lamina excision of C3,upper lamina resection of T1,C_（4 ~ 7）open- door vertebral canal plasty（ modified group）,another 73 cases were treated with C_3 to C_7single door enlargement of the spinal canal plasty（ traditional group）. Data needed to be recorded included the operative time,intraoperative bleeding volume,postoperative drainage volume,and the neurological function was evaluated according to the Japanese Orthopaedic Association（ JOA）score system before and after the operation,finally,the improvement rate were calculated in both two groups. The cervical curvature and shoulder and neck pain VAS score were recorded and statistically analyzed. [Results] Follow up time ranged from 12 to 47 months,with an average of 23 months. The operation time was reduced in the modified group than in the traditional group,with significant difference（ P 0. 05）. While there was no significant difference in the amount of blood loss and the volume of drainage between two gorups（ P 0. 05）. After 12 months of follow- up,JOA improvement rate showed no difference between two groups（ P 0. 05）. At the last follow- up,significant difference was found in cervical lordosis,indicating that the modified technique could maintain cervical flexion more preferablely than conventional technique. In the modified group,the VAS score of neck shoulder pain was significantly lower than that of the traditional group,and the difference between the two groupswas significant. No severe complications was found in the two groups such as cerebrospinal fluid leakage,wound infection,and vertebral lamina. No internal fixation loosening, extrusion, broken was found during the follow- up period. [Conclusion]Modified expansive open- door cervical laminoplasty preserving muscle attachment points of C_2 and C_3 spinous process can protect posterior cervical extensor muscles such as semispinalis,and at the same time,achieve pinal canal decompression in five lamina length. Therefore,it can shorten the operation time,get the same effect of decompression with the traditional operation method,and can better maintain cervical lordosis angle,reduce the incidence of neck shoulder pain.