限制性椎板切除术后颈椎曲度大小与脊髓后移的关系及对轴性症状的影响

Relationship between Cervical Curvature and Spinal Cord Posterior Movementafter Limited Laminectomy and Its Effect on Axial Symptoms

观察颈椎后路限制性椎板减压术后颈椎曲度大小与颈髓后移距离的关系及对手术疗效的影响。2016年1月至2017年12月,有87例颈椎曲度正常的脊髓型颈椎病患者在邯郸市中心医院接受限制性椎板切除术治疗,其中有74例获得完整的临床随访。术后根据harrison方法测量颈椎曲度并将其分为:A组,颈椎曲度变减小(0°≤颈椎角≤16.5°);B组,颈椎曲度正常(颈椎角>16.5°)。术后观察两组患者神经功能改善情况、脊髓后移距离、颈椎活动度(range of motion,ROM)、轴性症状严重程度及C5神经麻痹发生情况。在平均23.8个月的临床随访中,36例患者(A组)的颈椎曲度变小(48.6%),平均颈椎角为9.7°±5.3°;38例患者(B组)颈椎曲度维持正常(51.4%),颈椎角为18.7°±4.6°,两组颈椎曲度比较具有显著统计学差异(P<0.05);A组椎板切除宽度为(18.5±2.1)mm,B组为(17.9±1.8)mm,差异无统计学意义(P>0.05);A组脊髓后移距离为(1.8±0.5)mm,B组为(2.6±0.8)mm,具有显著统计学意义(P<0.05)。术后两组患者的ROM较术前无明显减小(P>0.05),日本矫形外科协会(Japanese Orthopaedic Association,JOA)评分均较术前有明显升高(P<0.05),组间比较无显著统计学差异(P>0.05);A组轴性症状严重程度明显重于B组(P<0.05);A组有3例(8.3%)患者发生C5神经麻痹,B组有4例(10.5%),两组比较无统计学差异(P>0.05)。以上结果表明,限制性椎板切除术后仍有近半数的患者出现颈椎曲度丢失,颈椎曲度减小使得脊髓后移距离缩短并增加轴性症状的严重程度,而颈椎曲度与神经恢复效果及C5神经麻痹无明显关联。

The research was aim to observe the relationship between cervical curvature and the distance of cervical cord shift after posterior limited laminectomy and its effect on surgical outcome.From January 2016 to December 2017,87 patients with cervical spondylotic myelopathy were treated with limited laminectomy in Handan Central Hospital,and 74 of them received complete clinical follow-up.Patients were divided into 2 groups according to the cervical curvature measured by Harrison.The cervical curvature of patients in Group A decreased(0°≤cervical vertebra angle≤16.5°),and the cervical curvature of patients in group B was normal(cervical vertebra angle>16.5°).The neurological improvement,spinal cord drift distance,range of motion(ROM),axial symptoms and C5 paralysis were observed and analyzed.The results show that 36 cases in group A and the cervical vertebra angle is 9.7°±5.3°,and 38 cases in group B and the cervical vertebra angle is 18.7°±4.6°(P<0.05)during an average follow-up of 23.8 months.The laminectomy width in group A is(18.5±2.1)mm,and in group B is(17.9±1.8)mm(P>0.05).The spinal cord drift distance is(1.8±0.5)mm in group A and(2.6±0.8)mm in group B,which is statistically significant(P<0.05).The ROM in the 2 groups is not significantly decreased when compared with the pre-operative level(P>0.05),and the JOA scores are significantly increased than those before surgery(P<0.05).The axial symptoms based on VAS score in group A are significantly higher than that in group B(P<0.05).There are 3 cases(8.3%)of C5 palsy in group A and 4 cases(10.5%)of C5 palsy in group B(P>0.05).Nearly half of the patients have cervical curvature loss after limited laminectomy.The reduction of cervical curvature reduces the spinal cord drift distance and increases the severity of axial symptoms.The cervical curvature has no relationship with neurological recovery and C5 palsy.