多节段脊髓型颈椎病单开门减压术后轴性痛因素分析

Factor analysis of decompression affecting onset of postoperative axial pain following unilateral expansive laminoplasty for patients with multilevel cervical degenerative myelopathy

目的探讨多节段脊髓型颈椎病(MCDM)患者行单开门扩大成形联合开门侧Centrepiece微型板钉固定术后轴性痛(PAP)临床特点、病理机制及危险因素。方法对79例MCDM患者行单开门扩大成形联合开门侧Centrepiece微型板钉固定,手术节段均≥4个。根据是否发生PAP分为两组,PAP组(12例)和非PAP组(67例)患者,比较手术前后颈椎曲度、颈椎前凸指数、颈椎屈伸、侧弯和侧旋活动度差异,评估术前C_(2～7)节段颈椎曲度类型、大小及术前合并颈椎不稳与PAP发作的关系。结果 PAP组均接受非手术治疗,末次随访时基本改善。PAP组术前合并颈椎不稳比例高于非PAP组,差异有统计学意义(P<0.05)。PAP组术后颈椎屈伸活动度下降幅度大于非PAP组,差异有统计学意义(P<0.05)。结论术前合并颈椎不稳的MCDM患者行单开门扩大成形联合开门侧Centrepiece微型板钉固定,术后更易继发颈椎屈伸活动度的下降和颈肩PAP。

Objective To investigate clinical characteristics,pathological mechanism and risk factors of postoperative axial pain（ PAP） after decompression of unilaterally expansive laminoplasty with open-side fixation of Centrepiece mini-plates system for treating multilevel cervical degenerative myelopathy（ MCDM）. Methods The 79 MCDM patients with ≥4 operated segments who underwent unilateral en bloc laminoplasty instrumented with Centrepiece miniplates of open-side were entrolled,who were divided into two groups according to occurrence of PAP or not,they were PAP group（ 12 cases） and non-PAP group（ 67 cases）. The differences of preoperative and postoperative values of cervical curvature,cervical lordosis index,range of angular motion from flexion to extension,lateral bending and rotation were compared between PAP and non-PAP groups. The correlations of preoperative type or dimension of cervical curve of C2～7segments as well as cervical instability and prevalence of PAP were evaluated,respectively. Results Twelve patients with PAP accepted non-surgical treatment,and got fundamental improvement at the final follow-up.The ratio of concomitantly preoperative instability in PAP group was higher than that in non-PAP group,the difference had statistical significance（ P〈0.05）. Postoperative amplitude of reduction of sagittally angular motion in PAP group was more than that in non-PAP group,the difference had statistical significance（ P〈0.05）. Conclusions If MCDM patients are complicated with preoperative cervical instability,pronounce loss of sagittal amplitude of motion and secondary onset of PAP of neck and shoulder will be incurred easily after unilaterally expansive laminoplasty adjuncted with fixation of Centrepiece mini-plates and screws of open-side.