内窥镜下2种微创颈椎椎管成形术术式的对比

Comparison of 2 kinds of minimally invasive laminoplasty by microendoscopic technique

目的探讨内窥镜下2种微创颈椎椎管成形术（cervical minimally invasive lamionplasty,CMIL）治疗多节段脊髓型颈椎病（cervical spondylotic myelopathy,CSM）的操作方法及临床疗效。方法 2012年3月-2014年9月,应用后路内窥镜下CMIL治疗CSM患者62例,其中应用普通微型钛板31例（A组）,采用颈后方韧带复合体＂先后移再固定＂的方式;应用新型微型钛板31例（B组）,采用颈后方韧带复合体＂先固定再后移＂的方式。比较2组患者的手术时间、术中出血量。依据日本骨科学会（Japanese Orthopaedic Association,JOA）评分和曾岩等标准分别评估疗效及轴性症状（axial symptom,AS）。术后即刻及3、6、12个月门诊随访,以后每年随访1次。结果 62例患者均获得随访。术后随访12-30个月,平均14个月。B组在出血量和手术时间方面均优于A组,差异具有统计学意义（P〈0.05）。A组、B组术后12个月JOA评分平均改善率分别为65.0%和63.0%,组间比较差异无统计学意义（P〉0.05）。A组、B组AS发生率分别为16.1%和19.3%,组间比较差异无统计学意义（P〉0.05）。结论内窥镜下2种CMIL治疗多节段CMS的临床疗效相似。内窥镜下应用新型微型钛板,采用颈后方韧带复合体＂先固定再后移＂的方式行CMIL,具有更为安全、手术时间更短、出血量更少且操作简便的优势。

Objective To explore the clinical outcome of 2 kinds of cervical minimally invasive laminoplasty（ CMIL） for cervical spondylotic myelopathy（ CSM） by microendoscopic technique. Methods Form March 2012 to September 2014,62 cases with CSM were treated with CMIL by microendoscopic technique,and all the cases were divided into 2 groups. Thirtyone patients underwent ＂first restroposition then fixation＂of ligament complex with general titanium mini-plating（ Group A）;Other 31 patients underwent＂first fixation then restroposition＂of ligament complex with new-type titanium mini-plating（ Group B）. Operation time and intraoperative estimate blood loss of 2 groups were compared. Effect and axial symptom（ AS） were evaluated according to Japanese Orthopedic Association（ JOA） scores and Zengyan Criterion,respectively. Follow-ups were carried out at immediate and 3,6,12 months after operation,and then once a year. Results All patients were followed up.The follow-up time ranged 6-30 months with a mean value of 14 months. The operation time and intraoperative estimate blood loss in Group B were less than those in Group A. There was significant difference between 2 groups（ P〈0. 05）. The mean JOA score improvement rate was 65. 0% for Group A and 63. 0% for Group B at 12 months after operation. There was no significant difference between 2 groups（ P〈0. 05）. The occurrence rate of AS was 16. 1% for Group A and 19. 3% for Group B. There was no significant difference between 2 groups（ P〈0. 05）. Conclusion Two kinds of CMIL by microendoscopic technique are effective for CSM. The latter has the advantages of simplicity, safety, shorter operation time and less intraoperative estimate blood loss.