改良单开门椎板成形术与椎板减压融合内固定术治疗多节段脊髓型颈椎病的效果比较

Modified cervical open-door laminoplasty versus cervical laminectomy and fusion for treatment of multilevel cervical myelopathy

目的比较改良单开门椎板成形术（MOLP）与椎板减压融合内固定术（LIF）治疗多节段脊髓型颈椎病的临床效果,并比较术后并发症的差异。方法 选择2009年6月~2013年6月在西京医院诊治的245例多节段（≥3节）脊髓型颈椎病患者,分别采用MOLP（A组,118例）及LIF（B组,127例）治疗。回顾性观察并比较手术时间及术中出血量,和术前及术后神经功能恢复情况（JOA评分）、颈椎功能障碍指数（NDI）、视觉模拟评分（VAS）、颈椎曲率指数（CCI）、颈椎的活动度（ROM）及术后并发症等指标评价两组手术疗效。结果 两组手术时间、术中出血量相比差异无统计学意义。两组患者术前JOA、ROM、NDI、VAS、CCI比较,差异无统计学意义（P〉0.05）。两组术后6月及1年JOA、NDI及VAS较术前显著改善（P〈0.05）,CCI与术前比较差异无统计学意义（P〉0.05）,ROM与术前相比明显下降（P〈0.05）。两组术后6月及1年JOA、CCI比较差异无统计学意义（P〉0.05）,术后6月及1年A组NDI及VAS均明显低于B组,而ROM均明显高于B组,差异有统计学意义（P〈0.05）。除A组ROM明显降低（P〈0.05）外,其余各组各指标术后6月与术后1年比较差异无统计学意义（P〉0.05）。结论 两种术式在治疗多节段脊髓型颈椎病时临床疗效相似,MOLP能够保留颈椎活动度,并发症发生率低,是治疗MCSM的理想手术方式。

Objective To compare the clinical outcomes and postoperative complications between modified cervical open-door laminoplasty and cervical laminectomy and fusion in treating multilevel cervical myelopathy. Methods From June 2009 and June 2013, !n Xijing Hospital, 245 patients with multilevel cervical myelopathy （I〉3 segments） were selected. 118 cases were treated with modified cervical open-door laminoplasty （group A）, the other 127 cases were treated with cervical laminectomy and instrumented fusion （group B）. The operation time and intraoperative blood loss during operation were retrospectively reviewed. Improvement of neurological function （J：OA）, neck disability index（NDI）, visual analog scale （VAS）, cervical curvature index （CCI）, cervical range of motion （ROM）, the complications prior to operation and post operation were evaluated as clinical efficacy. Results The operative time and blood loss between two groups were compared, the differences were not statistically significant （P 〉 0.05）. The JOA, cervical ROM, NDI, VAS and CCI of two groups before operation were compared, the differences were not statistically significant （P 〉 0.05）; JOA, NDI and VAS of two groups at 6 month and 1 year after operation were significantly improved than before operation （P 〈 0.05）, CCI of of two groups before operation were compared, the differences were not statistically significant （P 〉 0.05）, and ROM decreased than before operation （P 〈 0.05）; the JOA and CCI of two groups at 6 months and 1 year after operation was compared, the differences were not statistically significant （P 〉 0.05）, NDI and VAS of group A at 6 months and 1 year after operation were lower than those of group B , ROM of group A at 6 months and 1 year after operation were higher than those of group B, the differences were statistically significant （P 〈 0.05）. Except the ROM decrease in group A, the other indicators of two group at 6 months compared with those at 1 year after operation, the differences were not statistically significant （P 〉 0.05）. Conclusion Both methods can effectively treat the multilevel cervical myelopathy with similar clinical efficacy, modified cervical open-door laminoplasty as ideal option for patients with multilevel cervical myelopathy can more effectively preserve cervical ROM with less complications.