单开门椎板成形术起始节段对术后颈椎后凸的影响

Effect of the proximal level on post-laminoplasty loss of lordosis

目的:分析颈椎后路单开门椎板成形术中,是否保留C_2附着的肌肉韧带复合体,术后对颈椎后凸畸形的影响。方法:对2011年2月至2014年6月因脊髓型颈椎病接受颈后路单开门椎板成形术中选择病例进行回顾性分析,其中采用C_3-C_6单开门的患者40例(A组),男28例,女12例,年龄(68.4±9.3)岁;采用C_4-C_6单开门+C_3椎板减压患者40例(B组),从而保护C_2附着的肌肉韧带复合体,男26例,女14例,年龄(66.8±8.4)岁。术前及末次随访时观察颈痛VAS评分、JOA评分、颈椎Cobb角、颈椎活动度。结果:所有患者获得随访,时间24~31(26.5±3.4)个月。两组患者术前的VAS、JOA评分及颈椎活动度差异无统计学意义(P>0.05),末次随访均得到改善(P<0.05),组间比较差异无统计学意义;两组患者的颈椎Cobb角术前差异无统计学意义,术后也都有明显改善,但B组的改善优于A组。结论:从C_4开始单开门,保留C_2附着的肌肉韧带复合体,能明显减少颈椎的后凸畸形。

Objective：To analyze the effect whether or not retaining muscle ligament complex of C2 attachment on cervical spine kyphotic deformity after single open door laminoplasty. Methods：A total 40 patients with cervical spondylotic myelopathy underwent single open door laminoplasty from February 2011 to June 2014 were retrospectively analyzed. Of them,single open door for C3-C6 was 40 cases（group A）,including 28 males and 12 females,with an average age of（68.4±9.3） years old;and single open door for C4-C6 plus C3 laminectomy decompression（in order to protect the muscle ligament complex of C2 attachment） was 40 cases（group B）,including 26 males and 14 females,with an average age of（66.8±8.4） years old. Japanese Orthopaedic Association（JOA） score,visual analogue scale（VAS）,Cobb angle of sagittal plane from C2-C7,cervical range of motion were used to evaluate effects before operation and at the latest follow up. Results：All the patients were followed up from 24 to 31 months with an average of（26.5±3.4） months. There was no significant differences in VAS,JOA scores and cervical range of motion before surgery between two groups（P〉0.05） and all above items were significantly improved at the latest follow up（P〈0.05）,but there was no significant difference between two groups（P〉0.05）. There was no significant difference in cervical Cobb angle before surgery between two groups（P〉0.05）,and postoperative Cobb angle had obviously improved in two groups（P〈0.05）,but the improvement of group B was better than that of group A. Conclusion：Starting the laminoplasy on C4 level and retainning the muscle ligament complex of C2 attachment can obviouly decrease cervical spine syphotic deformity.