脊髓矢状位形态对颈后路单开门椎管成形术治疗脊髓型颈椎病的意义

Sagittal spinal cord morphology and the outcomes of posterior single open-door laminoplasty for multi-segmental cervical spondylotic myelopathy

目的：探讨脊髓矢状位形态对于颈后路单开门椎管成形术治疗多节段脊髓型颈椎病的意义。方法：回顾性分析2013年3月~2015年1月经皖南医学院弋矶山医院脊柱外科诊治的多节段脊髓型颈椎病患者的临床资料,按MRI T2加权像上脊髓的不同形态分为前凸、中立和后凸3组。评价指标：日本骨科协会评估治疗分数（JOA）、JOA缓解率。结果：术前3组患者的年龄、性别、术前JOA评分、术后JOA评分以及JOA缓解率之间比较差异无统计学意义（P〉0.05）。术后3组患者年龄、性别之间比较差异无统计学意义（P〉0.05）,但术后JOA评分前凸组和后凸组之间差异有统计学意义（P〈0.01）,JOA缓解率前凸组、中立组分别与后凸组比较差异有统计学意义（P〈0.01）,前凸组和中立组差异无统计学意义（P〉0.05）。结论：颈后路单开门椎管成形术治疗多节段CSM具有较好的疗效,术后脊髓形态为前凸型和中立型的患者较后凸型患者神经功能恢复更好,获得更佳的手术效果。

Objective：To investigate the effects of sagittal shape of spinal cord on the outcomes of postenior single open-door laminoplasty in treatment of multi-segmental cervical spondylotic myelopathy（CSM）.Methods：Clinical data were retrospectively analyzed in 53 patients with multi-segmental CSM undergone posterior single open-door laminoplasty in our hospital between March 2013 and January 2015.The patients were allocated to group of anterior,neutral or posterior convex by shape of spinal cord exposed on T2-weighted image of MRI,then evaluated with the Japanese Orthopaedic Association（JOA）score for recovery rate.Results：The three groups of patients were not significant concerning the age,gender,preoperative and postoperative JOA scoring and recovery rate（P 〉 0.05）,and the difference was also no significant between ages and genders in the three groups of patients（P 〉 0.05）.However,postoperative JOA scoring was different between patients with anterior convex and with posterior convex（P 〈 0.01）,and the recovery rate was also different those with anterior convex,neutral or posterior convex（P 〉 0.01）,yet there was no difference between patients with anterior convex and neutral convex（P 〉 0.05）.Conclusion：Postenior single open-door laminoplasty may be better therapeutic effects on the multi-segmental CSM,and the effects can be favorable to the recovery of neurological function in patients with spinal cord shape of anterior convex and neutral convex.