改良法与传统法椎管扩大成形术治疗老年多节段脊髓型颈椎病的对比

Titanium miniplate fixation of one-door-open laminoplasty in the treatment of multilevel cervical myelopathy in aged patients

目的:探讨改良椎管扩大成形术与传统椎管扩大成形术治疗老年多节段脊髓型颈椎病的临床效果。方法:回顾性分析2010年1月至2014年1月多节段脊髓型颈椎病老年患者行传统椎管扩大形术32例(A组);改良椎管扩大形术26例(B组)。两组患者平均年龄(64.5±7.2)岁。对两组手术时间、术中出血量、术后引流量进行比较;术后JOA评分、颈椎活动度、术后轴性疼痛、初始疼痛程度VAS评分及缓解时间的差异等情况进行评估。结果:术后切口均一期愈合,A组手术时间较长、术中出血量较多、术后引流量较多,与B组比较差异有统计学意义(P<0.05);术后6个月轴性症状发生率:A组为34.3%(11/32),B组为15.4%(4/26);术后JOA评分比较差异无统计学意义(P>0.05),两组患者初始VAS评分、疼痛出现和完全缓解时间比较差异均有统计学意义(P<0.05)。两组颈髓受压程度较术前明显改善。结论:改良式椎管扩大成形术治疗老年多节段脊髓型颈椎病,在术后轴性疼痛改善方面较传统法更具有优势。

Objective To investigate the clinical effect of titanium plate fixation in traditional and improvement laminoplasty in the treatment of elderly patients with multi segmental spinal cord type of cervical spondylosis. Methods To retrospect the clinical effect of titanium plate fixation in traditional and improvement laminoplasty in the treatment of elderly patients with multi segmental spinal cord type of cervical spondylosis in58 cases from January 2010 to January 2014. The reseach contained A group in fixation of C3-C7 and B group in fixation of C4-C6. The patient ＇s age was 64.5 ± 7.2y. X-ray, CT and MR examinations were performed before the operation and JOA score was estimated at 7d and 6 months after surgery. MRI showed the severity of cord compression. Cervical range of motion, axial pain, VAS score, and the duration for complete remission were evaluated after surgery. Results All incisions healed by the first intention. The incidence of axial pain after surgery was 34.3% in the group A and 15.4% in group B. There were no significant in the JOA score.There were significant in VAS score. The onset of pain and complete remission and spinal cord compression was improved at 6 months. Conclusion Improvement laminoplasty has more advantages than traditional laminoplasty in the treatment of multilevel cervical myelopathy in aged patients in VAS score, and the onset of pain and complete remission.