颈后路单开门椎管扩大成形术临床疗效影响因素的研究

Analysis of Prognostic Factors Related with the Clinical Outcomes after Expansive Open-door Laminoplasty

目的探讨影响颈后路单开门椎管扩大成形术(ELAP)临床疗效的相关因素。方法选取30例采用ELAP治疗并获得24月以上随访的患者,评测患者术前JOA评分、术后末次随访JOA评分,测量患者颈椎管正中矢状径增加距离(SCD)、开门距离(LOS)、开门角度(LOA)、术前颈椎前凸角度(LA),并结合年龄、性别、手术时间、术中出血等参数,研究以上参数之间及其与术后JOA评分改善率的相互影响关系。结果患者术前JOA评分平均分为(10.13±2.16),术后JOA评分平均分为(13.97±1.78),JOA评分改善率为(56.22±22.47)%。年龄≥70岁则JOA评分改善率明显下降,与其他年龄组比较,差别有统计学意义(P<0.05);不同性别组之间JOA评分改善率无明显差别(P>0.05);术前、术后JOA评分具有显著正相关(P<0.01);年龄与术前评分间无显著相关,与术后JOA评分具有显著负相关(P<0.05);SCD,LOS及LOA 3者之间呈显著相关(P<0.01);LA与SCD,LOS,LOA无相关;术后JOA评分改善率与LOS呈显著相关(P<0.01),与SCD呈显著相关(P<0.05)。结论SCD,LOS及LOA 3者之间呈显著相关;术后JOA评分改善率与LOS,SCD呈显著相关;LOS及SCD对ELAP临床疗效有显著影响。

Objective To detect the factors that affect the prognosis of expansive open-door laminoplasty. Methods 30 patients who underwent expansive open-door laminoplasty were selected and were followed upfor more than 24 months. The preoperative JOA scores and the last follow-up JOA scores were obtained. The increase in sagittal canal diameter（SCD）,the laminoplasty opening size（LOS）,the laminoplasty opening angle（LOA）,and C3-C7lordosis angle（LA）were measured by the imaging data in perioperative period. With consideration of age,sex,operation time and bleeding during the operation,the association among the above mentioned parameters were analyzed. We also analyzed the relationship between those parameters and improvement rate of nerve function postoperatively. Result The preoperative average JOA scores was（10.13±2.16）and the postoperative average JOA scores was（13.97 ± 1.78）at the last follow-up. The average improvement rate of nerve function was（56.22±22.47）%. The analysis showed that when the age was 70 or older,the improvement rate of JOA scores significantly decreased,and the difference in age was statistically significant（P〈0.05）.There was no significant difference in improvement between different gender groups（P〈0.05）;The preoperative JOA scores and the postoperative JOA scores were related positively significantly（P〈0.01）.The age was not related with the preoperative JOA scores,but it was related negatively significantly with the postoperative JOA scores（P〈0.05）. The SCD,LOS and LOA were related with each other significantly（P〈0.01）. The LA was not related with the SCD,LOS or LOA;The improvement rate of nerve function and the LOS were related significantly（P〈0.01）. The improvement rate of nerve function also was related to the SCD（P〈0.05）. Conclusion The SCD,LOS and LOA are related significantly.The LOS and SCD are related significantly with the improvement rate of nerve function after ELAP.