改良单开门椎板成形术治疗多节段脊髓型颈椎病

Modified open-door laminoplasty for multiple-segment cervical spondylotic myelopathy

[目的]探究改良颈后路单开门椎板成形术治疗多节段脊髓型颈椎病的临床效果。[方法] 2012年7月~2014年3月,78例多节段脊髓型颈椎病患者纳入本研究。采用随机数字表法分为两组,40例采用传统单开门椎板成形术,38例采用改良单开门椎板成形术。比较两组围手术期、随访及影像资料。[结果]术后两组各有1例血肿形成,及时手术血肿清除,神经症状均显著改善。改良组在手术时间、术中出血量和引流量均优于传统组,差异有统计学意义(P<0.05)。随时间推移,两组患者VAS评分显著减少(P<0.05),mJOA评分显著增加(P<0.05)。术后6个月和末次随访时,改良组的VAS和mJOA评分均优于传统组,差异有统计学意义(P<0.05)。影像方面,两组间颈椎ROM、颈椎前凸指数、椎管扩大率和脊髓后移度的差异均无统计学意义(P>0.05)。[结论]改良颈后路单开门椎板成形术治疗多节段脊髓型颈椎病的临床效果略优于传统术式。

[Objective]To explore the clinical outcomes of modified open-door laminoplasty for multiple-segment cervical spondylotic myelopathy.[Methods]From July 2012 to March 2014,78 patients who were undergoing surgical procedures for multiple-segment cervical spondylotic myelopathy,were enrolled into this study and randomly divided into two groups.Of them,40 patients received conventional open-door laminoplasty,while the remaining 38 patients had modified open-door laminoplasty performed.The perioperative,follow-up and radiographic documents were compared between the two groups.[Results]Two patients,one in each group,suffered from incision hematoma after operation,which were debrided as soon as diagnosed,and recovered well without serious consequences.The modified group was superior to the conventional group in operation time,intraoperative blood loss and postoperative drainage despite of the fact that no statistical significances were proved in aforesaid parameters between the two groups(P>0.05).The VAS score significantly decreased,whereas the JOA score significantly increased in both groups as time went(P<0.05).The modified group was superior to the conventional group regarding to VAS and JOA scores at 6 months and the latest follow-up,nevertheless there were no statistically significant differences between them(P>0.05).In term of imaging assessments,there were no statistical differences in cervical range of motion measured on dynamic lateral films,extent of cervical lordosis on neutral position,enlarged ratio of the canal and posterior displacement of the spinal cord between the two groups(P>0.05).[Conclusion]This modified unilateral open-door laminoplasty is slight superior to the conventional procedure in clinical outcomes for treatment of multiple-segment cervical spondylotic myelopathy.