颈椎椎板成形术结合维生素B12治疗合并脊髓亚急性联合变性的脊髓型颈椎病

Cervical expensive open-door laminoplasty combined with vitamin B12 treatment for patients of cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord

目的探讨颈椎椎板成形术结合维生素B12治疗合并脊髓亚急性联合变性的脊髓型颈椎病的临床疗效。方法回顾性分析2013年2月至2015年8月收治的10例脊髓型颈椎病合并脊髓亚急性联合变性的患者资料，男7例，女3例；年龄32-73岁，平均46岁；8例病程在6个月内，2例超过6个月。10例患者均行颈后路单开门椎管扩大成形钛板内固定术，并肌内注射或口服维生素B12。术后根据影像学资料评估手术前后颈椎稳定性、内固定物位置及脊髓受压情况；采用日本骨科协会（Japanese Orthopaedic Association，JOA）脊髓功能评分表对颈脊髓功能进行评分，并计算术后神经功能改善率；应用美国脊髓损伤协会（American Spinal Injury Association，ASIA）分级评价患者手术前后神经功能；对手术前、后的维生素B12水平及体感诱发电位数值变化情况进行对比；采用生活质量评价SF-36量表对各维度术前、术后的评分变化进行对比；对术前、术后JOA评分与维生素B12水平变化进行相关性分析。结果10例患者均获得门诊随访，随访时间6-26个月，平均15个月。术后影像学检查示10例患者无一例发生内固定松动、断裂及相关内固定并发症；MRIT2WI示C3-7脊髓周围脑脊液信号恢复连续；JOA评分由术前平均（9．6±2．04）分改善至术后平均（14．7±2．04）分；术后神经功能改善率为20％-80％，其中优4例、良5例、差1例，优良率为90％（9／10）；维生素B12水平由术前（78．30±42．82）pg／ml，提高至术后（176．50±85．77）pg／ml；ASIA评分由术前C级4例、D级6例改善至术后c级2例、D级5例、E级3例；体感诱发电位均有所恢复；手术前、后的维生素B12水平变化与神经功能评分有相关性。结论合并脊髓亚急性联合变性的脊髓型颈椎病可采用外科手术治疗，解除颈脊髓压迫，并为脊髓恢复创造空间，同时肌内注射或口服维生素B12可提高手术疗效。

Objective To investigate the clinical outcome of cervical expensive open-door laminoplasty combined with vitamin B12 treatment for patients of cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord. Methods Data of 10 patients with cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord in February 2013 to August 2013 were retrospectively analyzed. There were 7 males and 3 females with an average age of 46 years （range, 32-73 years）. Eight patients＇ history was in six months, and others＇ was beyond six months. All patients had undergone cervical expansive open-door laminoplasty with mini-plate fixation combined with intramuscular injection or pre os vitamin B 12. Patient imaging data were used to assess the stability of the cervical spine, and spinal cord compression in the fixed position before and after their surgery. Japanese Orthopaedic Association （JOA） score was used to evaluate function, and the rate of neurological improvement was calculated. The American Spinal Injury Association was used to evaluate the neurological function inpatients before and after surgery. The preoperative and postoperative numerical changes of SEP and vitamin B 12 were compared using correlation analysis. Each dimension of preoperative and postoperative scores change was compared by Life quality evaluation F- 36 scale. Results All patients were followed up for an average period of 15 months （range, 6-26 months）. There were no complications related to the internal fixation, such as fixation loosened or broken. Cerebrospinal fluid surrounding the spinal cord within the C3-7 range of the signal on MRI T2WI of the continuous had been recovered. JOA score increased from preoperative 9.6±2.04 to postoperative 14.7±2.04, and postoperative neurological improvement rate was 20%-80%. The excellent and good rate was 90% （9/10） including 4 excellent and 5 good. Vitamin B12 level before operation： 78.30±42.82 pg/ml, postoperative： 176.50±85.77 pg/ml. Electromyography and SEP had been all recovered. There was correlation between preoperative and postoperative vitamin B 12 levels with spinal cord function score. According to ASIA score, there were 4 cases in C level, 6 in D level preoperatively, while 2 in C level, 5 in D level, 3 in E level postoperatively. Conclusion Cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord could be treated by surgery. Vitamin B 12 by per os or intramuscular injection with removal of the cervi- cal spinal cord compression which creates a space for recovery of spinal cord could improve the surgical curative effect.