保留后方韧带复合体的改良式单开门椎板成形术治疗多节段脊髓型颈椎病

Treatment of multi-level cervical spondylotic myelopathy with modified unilateral open-door laminoplasty sparing the posterior ligament complex

目的研究保留后方韧带复合体的改良式单开门颈椎板成形术治疗多节段脊髓型颈椎病的临床疗效。方法选择2012年5月至2018年5月我科45例诊断为多节段脊髓型颈椎病予行保留后方韧带复合体的改良式颈椎单开门椎板成形术的患者作为研究组;选择同期43例行传统单开门椎板成形术的患者作为对照组。均采用钛钢板螺钉固定开门侧椎板及侧块。记录两组患者的手术时间、手术出血量、手术并发症情况,记录两组患者术前、术后3个月及末次随访时的日本骨科学会(JOA)评分、颈部功能障碍指数(NDI)评分、颈椎活动度(ROM)、颈椎曲度及术后颈部轴性症状的情况,末次随访按Odom标准评价疗效优良率。结果平均手术时间、平均出血量两组差异无统计学意义(P>0.05);末次随访时JOA评分改善率差异无统计学意义(P>0.05);NDI评分,术前及术后3个月组间比较无统计学差异(P>0.05),末次随访时组间差异有统计学意义(P<0.05),组内比较两组术前及末次随访时NDI评分差异有统计学意义(P<0.05)。末次随访时,对照组的颈椎整体平均曲度较术前减少(3.85±1.52)度,而研究组的颈椎整体平均曲度较术前减少(1.51±1.37)度,差异有统计学意义(P<0.05);对照组的整体颈椎活动度ROM较术前减少(6.81±2.31)度,研究组ROM较术前减少(4.68±1.93)度,差异有统计学意义(P<0.05)。术后对照组12例(27.9%)、研究组2例(4.4%)发生颈部轴性症状或加重,组间比较差异有统计学意义(P<0.05)。末次随访按Odom标准,对照组优32例,良6例,可5例,优良率88.4%;研究组优35例,良7例,可3例,优良率93.3%,组间比较差异有统计学意义(P<0.05)。结论保留后方韧带复合体的改良式单开门颈椎板成形术治疗多节段的脊髓型颈椎病临床疗效确切,相比传统单开颈椎板成形术,改良术式轴性症状发生率较低,术后颈椎曲度及颈椎活动度的影响小。

Objective To investigate the clinical efficacy of modified unilateral open-door cervical laminoplasty sparing the posterior ligament complex for treatment of multi-level cervical spondylotic myelopathy(MLCSM).Methods Included in this study were 45 patients who were diagnosed with MLCSM in our department between May 2012 and May 2018 and underwent modified unilateral open-door cervical laminoplasty with sparing of the posterior ligament complex.A total of 43 patients who underwent conventional unilateral open-door cervical laminoplasty during the same period were recruited as controls.Titanium steel plates and screws were used to for fixation of the laminae and lateral mass on the open-door side.The two groups were recorded for operation time,intraoperative blood loss,surgical complications,as well as the Japanese Orthopaedic Association(JOA)score,neck disability index(NDI)score,and cervical range of motion(ROM)at baseline,3 months after surgery,and at the last follow-up,cervical curvature,and postoperative axial symptoms of the neck.The rate of excellent efficacy was evaluated during the last follow-up according to Odom criteria.Results There was no significant difference in the mean operation time and blood loss between the two groups(P>0.05).At the last follow-up,there was no statistically significant difference in the improvement of JOA score between groups(P>0.05).The NDI score were comparable at baseline and at 3 months after surgery(P>0.05),but was statistically different between the two groups at the last follow-up(P<0.05).Within either group,the NDI score at the last follow-up was statistically different compared with baseline(P<0.05).At the last follow-up,the overall mean cervical curvature showed a reduction by(3.85±1.52)degrees from baseline in the control group,compared with a reduction by(1.51±1.37)degrees from baseline in the study group,with statistically significant difference between groups(P<0.05);the overall cervical ROM showed a reduction by(6.81±2.31)degrees from baseline in the control group,compared with a reduction by(4.68±1.93)degrees from baseline in study group,with statistically significant difference between groups(P<0.05).After surgery,12 patients(27.9%)in the control group vs 2(4.4%)in the study group developed or had worse axial symptoms of the neck,with statistically significant difference between groups(P<0.05).At the last follow-up,according to Odom criteria,the clinical efficacy was excellent in 32,good in 6,and fair in 5 patients in the control group(rate of excellent and good efficacy:88.4%);the clinical efficacy was excellent in 35,good in 7,and fair in 3 patients in the study group(rate of excellent and good efficacy:93.3%),with statistically significant difference between groups(P<0.05).Conclusion Modified unilateral open-door cervical laminoplasty sparing the posterior ligament complex is effective in the treatment of multi-level cervical spondylotic myelopathy.Compared with conventional unilateral open-door cervical laminoplasty,the modified surgery is associated with lower incidence of axial symptoms,and less impacts on postoperative cervical curvature and cervical range of motion.