椎管扩大成形术-发展及展望

The Development and Prospects of Cervical Laminoplasty

颈椎椎管扩大成形术作为椎板切除术的替代术式,通过将椎板抬高从而扩大脊髓可用空间,达到间接减压效果以治疗颈椎病。在Hirabayashi的单开门及Kurokawa的双开门两种原型技术基础上,各种椎管扩大成形术得以不断发展。相比于椎板切除术,多项研究表明椎板成形术后颈椎表现出更好的生物力学稳定性。椎管扩大成形术的最新研究进展围绕保留肌肉、韧带附着点,从而使由颈伸肌群控制的颈椎保持动态及静态稳定。接受了新型椎板成形术治疗的患者,结合术后积极的颈部肌肉功能锻炼,术后颈椎失稳、后凸畸形、轴性症状以及颈椎活动度的下降都进一步减少。多项临床试验表明这种新型术式可以保证患者术后疗效的同时提供颈椎的即刻稳定性。现就对颈椎椎管扩大成形术的发展、并发症以及未来趋势综述如下。

Cervical laminoplasty as an alternative for laminectomy,the lamina is raising cord thereby expanding the available space,to achieve indirect decompression effect treatment of cervical disease.Based on the two prototype of Hirabayashi's open-door and Kurokawa's double-door,a variety of spinal canal enlargement techniques have been developed.Compared to laminectomy,several studies have shown that the cervical spine exhibits better biomechanical stability after laminectomy.Recent advances in the treatment of spinal canal enlargement have focused on the retention of muscle and ligament attachment points,thereby maintaining the dynamic and static stability of the cervical vertebrae controlled by the cervical extensor muscle group.Patients who underwent a new type of laminectomy combined with postoperative active neck muscle function training,postoperative cervical instability,kyphosis,axial pain,and decreased activity were further reduced.A number of clinical trials have shown that this new procedure can provide immediate stability of the cervical spine while ensuring postoperative outcomes.