限制性椎板减压联合侧块螺钉固定对脊髓性颈椎病患者术后神经功能及轴性症状的影响

Effects of restrictive laminectomy with lateral mass screw fixation on postoperative neurological function and axial symptoms of patients with CSM

目的:观察限制性椎板减压联合侧块螺钉固定术与全椎板切除术在治疗多节段脊髓型颈椎病(M-CSM)的临床疗效及影像学差异。方法:回顾性选取73例接受颈后路手术治疗的M-CSM患者资料,根据手术方式的不同将其分为观察组(40例)和对照组(33例),观察组采用限制性椎板减压侧块螺钉固定术治疗;对照组采用常规全椎板减压术治疗。观察比较患者术后神经功能恢复、颈椎活动度(ROM)、颈椎曲度指数(CCI)、脊髓漂移距离、轴性症状及C5节段神经麻痹发生情况。结果:对照组患者的手术时间、术中出血量均低于观察组,其差异有统计学意义(t=6.076,t=4.713;P<0.05);观察组椎板切除宽度和脊髓漂移距离均小于对照组,其差异有统计学意义(t=9.157,t=8.211;P<0.05)。两组患者术后日本骨科协会(JOA)评分与术前比较显著增高,差异有统计学意义(F=48.818,F=46.521;P<0.05)。观察组在CCI的恢复及维持更有优势,两组比较差异有统计学意义(t=8.606,P<0.05);两组术后ROM比较差异有统计学意义(t=10.694,P<0.05);术后3 d和3个月,观察组轴性症状VAS评分均低于对照组,差异有统计学意义(t=5.361,t=7.754;P<0.05);观察组C5节段神经麻痹发生率低于对照组,差异有统计学意义(x^2=4.583,P<0.05)。结论:侧块螺钉固定可恢复并维持颈椎曲度,但存在颈椎活动度丢失,限制性椎板切除可促进神经功能显著恢复,限制脊髓向后漂移,有助于降低C5节段神经麻痹及轴性症状的发生。

Objective: To observe the differences of clinically therapeutic effect and iconography of restrictive laminectomy with lateral mass screw fixation and whole laminectomy in treatment for multilevel cervical spondylotic myelopathy(M-CSM). Methods: The data of 73 patients with M-CSM who received posterior approach operation of neck were retrospectively selected, and they were divided into observation group(40 cases) and control group(33 cases) according to different operative methods. The observation group adopted restrictive laminectomy with lateral mass screw fixation and control group adopted routine whole laminectomy. And the neural functional recovery post operation, range of motion(ROM) of cervical vertebra, cervical curvature index(CCI) of cervical vertebra, drift distance of spinal cord, axial symptoms and the occurrence of neural paralysis at C5 segment of patients were observed and compared. Results: The operative time and intraoperative blood amount of control group were significantly lower than those of observation group(t=6.076, t=4.713, P<0.05). The width of laminectomy and the drift distance of spinal cord were significantly less than those of control group(t=9.157, t=8.211, P<0.05). The postoperative JOA scores of two groups were significantly higher than preoperative scores of them(F=48.818, F=46.521, P<0.05). The recovery and keep of CCI of observation group were significantly better than those of control group(t=8.606, P<0.05). And the difference of postoperative ROM between the two groups was significant(t=10.694, P<0.05). At 3 d and 3 months post operation, VAS scores of axial symptoms of observation group were significantly lower than those of control group(t=5.361, t=7.754, P<0.05), respectively. Besides, the incidence of neural paralysis at C5 segment of observation group was significantly lower than that of control group(x^2=4.583, P<0.05). Conclusion: Lateral mass screw fixation can restore and maintain cervical curvature, while it has the problem that losses cervical activity. Restrictive laminectomy can promote a significant recovery for neurological function and restrict the backward drift of the spinal cord. It is help to reduce the occurrences of neural paralysis at C5 segment and axial symptoms.