棘突纵割式颈椎后路椎管扩大成形术治疗多节段重度颈椎管狭窄长期疗效分析

Long-term result analysis of posterior spinal process splitting laminoplasty for severe multilevel cervical spinal stenosis

目的评价棘突纵割式颈椎后路椎管扩大成型术治疗多节段重度颈椎管狭窄长期疗效。方法回顾分析2005年1月至2010年12月行颈椎后路椎管扩大成形术治疗多节段颈椎管狭窄138例。根据MRI影像将病例分为压迫组(椎管占据率<60%)和重度压迫组(椎管占据率≥60%)。比较2组的日本骨科协会(JOA)评分、JOA评分改善率和颈椎功能障碍指数(NDI)评分。结果压迫组72例,重度压迫组66例。2组年龄、性别、随访时间、手术时间和出血量差异无统计学意义。压迫组JOA评分为术前11.4±2.9,术后最佳14.7±1.7,末次随访13.6±3.0,术后明显改善(P=0.000);重度压迫组JOA评分为术前11.1±3.1,术后最佳15.0±2.0,末次随访14.2±2.5,术后明显改善(P=0.000)。2组间比较,术前、术后最佳及末次随访评分差异均无统计学意义。压迫组JOA评分改善率术后最佳时为(53.0±39.2)%,末次随访为(36.3±43.8)%,两者差异有统计学意义(P=0.018)。重度压迫组JOA评分改善率术后最佳时为(65.7±35.8)%,末次随访为(49.2±46.4)%,两者间差异有统计学意义(P=0.017)。2组间比较,最佳JOA评分改善率重度压迫组优于压迫组(P=0.037),末次随访JOA评分改善率差异无统计学意义(P=0.09)。压迫组NDI评分为术前23.9±12.4,术后最佳16.4±15.0,末次随访17.9±14.5,术前与术后评分差异有统计学意义(P=0.013)。重度压迫组NDI评分为术前23.8±12.8,术后最佳17.9±16.2,末次随访18.9±15.7,术后最佳时与术前评分差异有统计学意义(P=0.018),末次随访与术前评分差异无统计学意义。2组间NDI评分比较,术前、术后最佳和末次随访评分之间均无显著差异。结论棘突纵割式颈椎后路椎管扩大成形术是治疗多节段颈椎管狭窄的有效方法,无论椎管占据率是否超过60%,均可获得相近的临床改善效果。

Objective To evaluate the long-term results of posterior spinal process splitting laminoplasty for severe multilevel cervical spinal stenosis. Methods To review the patients underwent the posterior cervical spinal process splitting laminoplasty in Beijing Jishuitan Hospital from Jan 2005 to Dec 2010. One hundred and thirty-eight patients met the inclusion criteria and were divided into 2 groups according to the occupying rate on MRI： the compression group（ occupying rate 60%） and the severe compression group（ occupying rate ≥60%）. JOA score,recovery rate of JOA score and NDI were compared between 2 groups. Results There were72 patients in compression group and 66 patients in severe compression group. There were no significant difference in age,gender,operation time and blood loss between 2 groups. JOA scores of the compression group were 11. 4 ± 2. 9 at pre-operation,13. 6 ± 3. 0 at last follow-up and 14. 7 ± 1. 7 was the best during follow-up.There was significant difference between pre-operation and post-operation（ P = 0. 000）. JOA scores of the severe compression group were 11. 1 ± 3. 1 at pre-operation,14. 2 ± 2. 5 at last follow-up and 15. 0 ± 2. 0 was the best during follow-up. There was significant difference between scores at pre-operation and post-operation（ P = 0. 000）. However,there was no significant difference among pre-operation score,last follow-up score and the best post-operative score between 2 groups. Recovery rate of JOA score of compression group were（ 36. 3 ±43. 8） % at last follow-up and（ 53. 0 ± 39. 2） % at the post-operative best. There was significant difference between them（ P = 0. 018）. Recovery rate of JOA score of the severe compression group were 49. 2 ± 46. 4 at last follow-up and 65. 7 ± 35. 8 at the best during follow-up. There was significant difference between them（ P =0. 018）. There was no significant defference between the best recovery rate of JOA score of the 2 groups（ P =0. 09）.NDI of compression group were 23. 9 ± 12. 4 at pre-opeation,17. 9 ± 14. 5 at last follow-up and 16. 4 ±15. 0 was the best during follow-up. There was significant difference between scores of pre-operation and followup（ P = 0. 013）.NDI of severe compression group were 23. 8 ± 12. 8 at pre-opertaion,18. 9 ± 15. 7 at last follow-up and 17. 9 ± 16. 2 at the best during follow-up. There was significant difference between NDIs at preoperation and the best time（ P = 0. 018）. There was no significant difference between NDIs at pre-operation and last follow-up（ P = 0. 09）.There was no significant difference between NDIs of the 2 groups at pre-operation,the best time during follow-up and the last follow-up. Conclusion Posterior cervical spine laminoplasty is effective for multilevel cervical spine stenosis. Whether the compression rate is less than 60% or over 60%,the similar clinical efficacy could be achieved.