改良椎板悬吊单开门椎管成形术与传统术式治疗颈椎病的对比研究

A comparison between modified open door laminoplasty and traditional operation for the treatment of cervical spondylosis

目的比较改良椎板悬吊单开门椎管成形术与传统单开门椎管成形术治疗多节段颈椎病合并颈椎不稳的疗效。方法回顾性分析2012年5月至2014年10月,使用改良椎板悬吊单开门椎管成形术（改良组）或传统单开门椎管成形术（传统组）治疗的69例颈椎病合并颈椎不稳患者临床资料。改良组患者38例,平均年龄52.6（42-67）岁;男25例,女13例。传统组31例,平均年龄55.4（35-69）岁;男18例,女13例。记录两组患者手术时间,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1周及随访时椎板开门角度等,并进行比较。结果两组手术时间、出血量差异无统计学意义（P〉0.05）。两组术前JOA、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、VAS评分差异无统计学意义（P〉0.05）,两组术后1周椎板开门角度差异无统计学意义（P〉0.05）,末次随访时改良组开门角度为（43.27±8.82）°,传统组为（37.42±7.42）°,差异有统计学意义（P〈0.01）。传统组7例（22.6%）出现轴性症状,改良组5例（13.2%）;传统组4例（12.9%）出现C_5神经麻痹,改良组3例（7.9%）。结论改良椎板悬吊单开门椎管成形术与传统术式相比,不影响神经功能恢复,但可更好地减少椎板开门角度的丢失和椎板骨折移位。

Objective To compare the outcomes of modified open door laminoplasty with traditional operation for the treatment of cervical spondylosis. Methods From May 2012 to October 2014, 69 cases with cervical spondylosis combined with cervical instability, undergoing posterior laminoplasty and lateral mass screw fixation, were reviewed retrospectively. Thirty-eight cases undergoing modified open door laminoplasty were classified into the modified group, and 31 cases undergoing traditional open door laminoplasty were classified into the traditional group. The modified group included 25 males and 13 females with the mean age of 52.6 years（ range： 42- 67 years）. The traditional group included 18 males and 13 females with the mean age of 55.4 years（ range： 35- 69 years）. Operation time, blood loss, complications, pre- and post-operative Japanese Orthopedic Association（ JOA） score, neck Visual Analogue Scale（ VAS） score, and the open angle 1 week postoperatively were used for the comparison between 2 groups. Results There were no significant differences in operation time and blood loss between the 2 groups（ P 〉0.05）. Preoperative JOA and VAS scores were similar between the 2 groups（ P 〉0.05）. No significant differences were demonstrated in postoperative JOA score, improvement rate of JOA score, and postoperative VAS score between the 2 groups（ P 0.05）. Open angles 1 week postoperatively was similar between the 2 groups（ P 0.05）. Open angle at last follow-up in the modified group was maintained better than that in the traditional group [（ 43.27 ± 8.82） ° vs.（ 37.42 ± 7.42） °, P〈 0.01 ]. Seven cases（ 22.6%） in the traditional group and 5 cases（ 13.2%） in the modified group had axial symptoms after the surgery. Four cases（ 12.9%） in the traditional group and 3 cases（ 7.9%） in the modified group had C5 nerve root palsy after the surgery. Conclusions Modified open door laminoplasty can achieve similar clinical outcomes as the traditional operation, maintaining better open angle and reducing fracture dislocation than the traditional operation.