单开门椎管扩大治疗多节段脊髓型颈椎病患者退变性椎管狭窄

Expansive open-door laminoplasty for degenerative spinal stenosis in patients with multi-segmental cervical spondylotic myelopathy

目的探讨单开门椎管扩大治疗退变性椎管狭窄对多节段脊髓型颈椎病患者颈椎功能的保护作用。方法选择2013年4月至2015年1月西安市第九医院收治的多节段脊髓型颈椎病患者47例,其中男性32例,女性15例,年龄32~80岁。根据治疗方法将患者分为治疗组(25例,其中男性17例,女性8例;年龄32~80岁,平均年龄59.34岁;颈椎曲度正常或矢状面后凸≤13°,且3个节段退变性颈椎管狭窄;病程为2个月至3年,平均病程16.51个月)和对照组(22例,其中男性15例,女性7例;年龄34~78岁,平均年龄59.12岁;颈椎曲度正常或矢状面后凸≤13°,且3个节段退变性颈椎管狭窄;病程为2个月至3年,平均病程16.92个月)。治疗组行颈椎后路单开门椎管扩大椎板成形术,对照组行颈椎前路椎体次全切植骨融合术。观察两组患者手术情况,比较颈椎功能障碍指数(NDI)、日本骨科协会(JOA)评分、C_2~C_7颈椎整体活动度、Cobb角、C_5椎管/椎体比率和颈后肌肉群横截面。结果两组患者术前NDI、JOA、C_2~C_7颈椎整体活动度和C_5椎管/椎体比率比较,差异无统计学意义(P>0.05)。术后12个月时,与对照组比较,治疗组患者NDI显著降低(16.58±4.88 vs 19.73±4.37,P=0.025);JOA评分显著升高[(14.84±2.05)分vs(13.04±1.98)分;P=0.004];C2~C7颈椎整体活动度显著升高[(39.63±7.33)°vs(35.12±7.28)°;P=0.040];C_5椎管/椎体比率显著增高(0.91±0.18 vs 0.78±0.16;P=0.013)。两组患者术前、术后颈后肌肉群横截面、Cobb角、手术情况和术后并发症差异均无统计学意义(P>0.05)。结论单开门椎管扩大可治疗多节段颈椎病患者,减少了脊椎肌肉韧带复合体的损伤,术后颈部症状和功能恢复较传统手术更优,为临床提供新的治疗思路。

Objective To investigate the protective effect of expansive open-door laminoplasty on cervical spine function in patients with multi-segmental cervical spondylotic myelopathy. Methods From April 2013 to January 2015, a total of 47 cases with multi-segment cervical spondylotic myelopathy were retrospectively enrolled, which included 32 males and 15 females, aged 32-80 years old. According to treatment methods, all of them were divided into observation group（n = 25, included 17 males and 8 females; aged 32-80 years old with mean age of 59.34 years old; normal cervical curvature or sagittal kypho-sis ≤ 13°, and 3 segments cervical spinal stenosis; duration from 2-month to 3-year with mean duration of 16.51-month） and control group（n = 22, included 15 males and 7 females; aged 34-78 years old with mean age of 59.12 years old; normal cervical curvature or sagittal kyphosis ≤ 13°, and 3 segments cervical spinal stenosis; duration from 2-month to 3-year with mean duration of 16.92-month）. The observation group were performed cervical posterior expansive open-door laminoplasty,and control group underwent anterior cervical spine corpectomy of interbody fusion. The operation situation, neck disability index（NDI）, Japanese Orthopedic Association（JOA） score, range of motion（ROM） of C_2-C7, Cobb angle, C_5 vertebral canal/vertebral ratio and neck muscle cross section of 2 groups were observed. Results There were no significant differences in NDI,JOA, ROM of C_2-C7 and C_5 vertebral canal/vertebral ratio before operation between 2 groups（P〈0.05）. Compared with control group, NDI in observation group was significantly decreased after operation 12-month（16.58 ± 4.88 vs 19.73 ± 4.37; P =0.025）. The JOA score was significantly increased[（14.84 ± 2.05） scores vs（13.04 ± 1.98） scores; P = 0.004]. The ROM of C_2-C_7 significant elevated[（39.63 ± 7.33）° vs（35.12 ± 7.28）°; P = 0.040]; and C_5 vertebral canal/vertebral ratio significant increased（0.91 ± 0.18 vs 0.78 ± 0.16; P = 0.013）. There were no differences in cervical posterior muscles cross section, Cobb angle,operation situation and postoperative complications before and after operation between 2 groups（ P〈0.05）. Conclusion It is demonstrated that expansive open-door laminoplasty could be used to multi-segment cervical spondylosis, and reduce spinal muscle ligament complex damage. The postoperative neck symptoms and functional recovery is better than traditional opera-tion, which provide new treatment ideas for the clinical.