改良椎板悬吊单开门椎管成形术治疗多节段颈椎病的疗效观察

A modified open door laminoplasty for treatment of multi-level cervical spondylosis

[目的]评价改良椎板悬吊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~2014年10月收治的38例多节段颈椎病合并颈椎不稳的患者,男25例,女13例;年龄42~67岁,平均52.6岁。所有患者接受改良椎板悬吊单开门椎管成形联合侧块螺钉内固定术,术后评估颈椎JOA评分、颈部VAS评分改善及椎板开门角度变化情况,并分析记录并发症。[结果]手术时间(136±34)min,出血量(324±78)ml。平均随访27.3月(13~42月),术前JOA评分(9.64±2.38),术后提高至(14.62±3.21)(t=-12.96,P<0.01),JOA改善率67.66%。术前颈部VAS评分(6.37±2.16),术后降低至(3.25±2.41)(t=9.72,P<0.01)。术后1周颈椎开门角度46.41°±9.32°,末次随访时43.27°±8.82°,差异无统计学意义(t=1.64,P=0.11)。术后5例(13.2%)患者出现轴性症状,3例(7.9%)患者出现C5神经麻痹。[结论]改良椎板悬吊单开门椎管成形术治疗多节段颈椎病合并颈椎不稳,明显提高了患者神经功能,较好的维持了术后开门角度,早期效果满意。

[Objective] To evaluate the clinical outcome of a modified open door laminoplasty for the treatment of multilevel cervical spondylosis combined with cervical instability. [Methods] Thirty-eight patients （25 males, 13 females; mean age, 52.6 years; range, 42-67 years） with cervical spondylosis combined with cervical instability between May 2012 and October 2014 were analyzed retrospectively. All patients underwent a modified open door laminoplasty and lateral mass screw fixation. The cervical Japanese Orthopaedic Association （JOA） score, Visual Analogue Scale （VAS） score, postoperative open angle, and incidence of complication were recorded and analyzed. [Results] The operation time was 136±34rain, and blood loss was （324±78） ml. The average follow-up time was 27.3 months （range, 13±42 months） . Postoperative JOA score was significantly improved compared with preoperative score [（14.62±3.21） vs （9.64±2.38）, P〈 0.01 ], and the postoperative improvement rate of JOA score was 67.66%. Postoperative cervical VAS score was siguifieantly reduced compared with preoperative score [ （3.25±2.41） vs （6.37±2.16）, P〈0.01] . There was no significant difference in open angles at one week postoperatively and at the last follow-up [ （ 46.41°±9.32°） vs （43.27°±8.82°）, P=0.11]. Five patients had axial symptom and three patients were found C5 nerve root palsy after surgery. [ Conclusion] After using the modified open door laminoplasty in the treatment of multi-level cervical spondylosis combined with cervical instability, the neurological function can be improved significantly, with well maintained open angle.