保留C3、C7棘突的改良椎管扩大成形术治疗颈椎病的临床研究

Comparison between a modified open-door laminoplasty with reconstruction of the C3 and C7 spinous process and traditional operation for the treatment of cervical spondylosis

目的总结一种保留颈3、颈7棘突的改良单开门椎管扩大成形术与传统单开门椎管扩大成形术治疗多节段颈椎病的疗效比较。方法回顾性分析2012年5月至2014年10月应用改良单开门椎管成形术（改良组）或传统单开门椎管成形术（传统组）治疗的69例多节段狭窄颈椎病患者的临床资料。改良组患者38例,平均年龄51.2岁（42～67岁）;男25例,女13例;传统组患者31例,平均年龄52.4岁（35～69岁）;男18例,女13例。记录2组患者手术时间,出血量,术中及术后并发症,术前及术后随访日本骨科协会（Japanese Orthopedic Association,JOA）评分及颈部疼痛视觉模拟评分（visual analogue scale,VAS）,术后随访时颈椎总活动度等,并进行比较。结果 2组手术时间、出血量差异无统计学意义（P〉0.05）;2组术前JOA评分、VAS评分差异无统计学意义（P〉0.05）;术后JOA评分、神经功能改善率差异无统计学意义（P〉0.05）;2组术后1周时VAS评分改良组明显低于传统组（P〈0.05）;末次随访时颈椎总活动度改良组角度大于传统组（P〈0.01）;传统组13例（41.6%）患者出现轴性症状,改良组4例（10.5%）,2组比较差异有统计学意义（P〉0.05）;传统组4例（12.9%）患者出现C5神经麻痹,改良组3例（7.9%）。结论此种改良单开门椎管扩大成形术与传统术式相比,可明显减少术后轴性症状及颈部疼痛的发生,与传统组比较,神经功能改善率无统计学意义。

Objective To compare the modified expansive open- door laminoplasty with traditional single door more segmental construction of vertebral canal expansion laminoplasty for cervical spondylosis. Methods Sixty-nine patients with CSM from May 2012 to October 2012 were included into our retrospective study. Thirty-eight patients were included in the modified group, with the average age of 51.2 years（42-67）. Twenty-five were male, and 13 were female.Thirty- one patients were included into the traditional group with the average age of 52.4 years（35- 69 years）. Eighteen was male and 13 were female. The operation time, volume of blood loss, intraoperative and postoperative complications,preoperative and postoperative follow-up of the JOA score and neck pain VAS, range of motion were recorded and analyzed for the two groups. Results There was no difference in operation time, volume of blood loss,preoperative JOA /VAS, postoperatie JOA /VAS score nerve function period between the two group（P〈0.05）. The 1 week VAS score of the modified group was significantly lower than in the traditional group（P〈0.05）; At the end of follow-up, Angle movement had improved in the modified group（P〈0.01）. The modified group had less axial symtoms（4/38 10.5%） than the traditional group（13/31 41.6%）（P〈0.05）; and less C5 paralysis（3,7.9%） than the traditional group（4,12.9%）. Conclusion The modified expansive open-door laminoplasty can obviously reduce postoperative axial symptoms and the occurrence of neck pain. Compared with the traditional group, there is no statistical significant difference in nerve function period.