两种术式治疗颈椎管狭窄症后神经功能改善的效果分析

Analysis on neural function improvement effects of two kinds of operative mode for treating cervical canal stenosis

目的探讨后路椎板减压侧块内固定术与单开门椎管扩大成形术治疗颈椎管狭窄症(CCS)后神经功能改善的效果及术后C5神经根麻痹(C5P)的发生率。方法选取2011年3月至2013年3月于西安交通大学第一附属医院骨科行颈椎手术的CCS患者80例,其中40例行单开门椎板扩大成形术(观察组),40例行椎板切除减压侧块内固定术(对照组)。患者手术前后神经功能评分均行日本骨科学会(JOA)评分及影像学评估。结果两种术式均能有效改善神经功能。术后6个月内每次复查的JOA评分均较术前有所提高(P<0.05),且两组患者JOA评分比较差异无统计学意义(P>0.05);但两组患者术后C5P发生率比较,差异有统计学意义(P<0.05)。发现C5P患者椎间孔宽度与未发生者相比存在明显的狭窄(P<0.05)。结论脊髓漂移程度和椎间孔狭窄可能是C5P发生的重要因素,单开门椎板扩大成形术后C5P发生率较低。

Objective To investigate the neural function improvement effects and incidence of postoperative C5 nerve root palsy（C5P）in posterior vertebral lamina decompression lateral mass internal fixation and expansive single open-door laminoplasty for treating cervical canal stenosis（CCS）.Methods A total of 80 patients with CCS in the orthopedic department of the First Affiliated Hospital of Xi′an Jiaotong University from 2011 to 2013were selected and performed the cervical vertebral operation.Among them,40 cases underwent expansive single open-door laminoplasty（observation group）,while other 40 cases underwent vertebral lamina resection decompression lateral mass internal fixation.Both preoperative and postoperative JOA score and imageological evaluation were performed in the two groups.Results Both the two kinds of operative mode could effectively improve the neural function.The JOA scores in each re-examination within postoperative 6months were increased than before operation（P〈0.05）,moreover the JOA scores had no statistical difference between the two groups;the C5 P incidence had statistical difference between the two groups（P〈0.05）.It was found that the obvious stenosis existed in the intervertebral foramen width of C5 P patients compared with the non-C5 P patients（P〈0.05）.Conclusion The spine cord shift degree and intervertebral foramen stenosis could be the important factors of C5 P occurrence.The expansive single open-door laminoplasty has lower occurrence rate of C5 P.