保留半侧肌肉韧带的微型钛板固定颈椎单开门椎管扩大椎板成形术治疗多节段脊髓型颈椎病

Single-door laminoplasty with mini titanium plate fixation retaining hemilateral paraspinal muscle ligament complex for multilevel cervical spondylotic myelopathy

目的探讨保留半侧肌肉韧带的微型钛板固定颈椎单开门椎管扩大椎板成形术治疗多节段脊髓型颈椎病(MCSM)的临床疗效。方法回顾性分析2010年2月—2018年1月在重庆市中医骨科医院接受微型钛板固定颈椎单开门椎管扩大椎板成形术治疗的59例MCSM患者临床资料,其中28例保留颈椎半侧肌肉韧带(保留组),31例未保留颈椎半侧肌肉韧带(非保留组)。测量2组患者椎板开门角度、脊髓后漂移距离、颈椎活动度(ROM)及颈椎曲度等影像学参数。记录2组患者术中情况、日本骨科学会(JOA)评分、疼痛视觉模拟量表(VAS)评分以及术后并发症发生情况。结果保留组手术时间、术中出血量较非保留组高,住院天数短于非保留组,差异均有统计学意义(P<0.05)。2组椎板开门角度和脊髓向后平均漂移距离差异无统计学意义(P>0.05)。末次随访时,保留组ROM丢失较非保留组少;保留组颈椎曲度维持良好,非保留组颈椎曲度较术前明显减少;差异均有统计学意义(P<0.05)。2组JOA评分及其改善率差异无统计学意义(P>0.05),但保留组颈部VAS评分改善程度较非保留组显著,差异有统计学意义(P<0.05)。2组患者无感染、再关门及脊髓损伤等严重并发症出现,保留组轴性症状发生率显著低于非保留组,差异有统计学意义(10.7%vs.22.5%,P<0.05)。结论保留半侧肌肉韧带的微型钛板固定颈椎单开门椎管扩大椎板成形术治疗MCSM可取得与传统手术相似的神经减压效果,虽然手术步骤增加,但有利于减少轴性症状的发生和颈椎曲度的丢失。

Objective To explore the clinical efficacy of modified single-door laminoplasty with mini titanium plate fixation retaining hemilateral paraspinal muscle ligament complex in treatment of multilevel cervical spondylotic myelopathy(MCSM).Methods From February 2010 to January 2018,59 patients with MCSM who underwent single-door laminoplasty in Chongqing Orthopaedic Hospital of Traditional Chinese Medicine were retrospectively analyzed,among them,28 retained the unilateral paraspinal muscle ligament complex(retention group),and 31 cases underwent traditional single-door laminoplasty(non-retention group).The imaging parameters such as laminoplasty opening angle,the distance of spinal cord posterior drift,the range of motion(ROM)and cervical curvature were measured.The intraoperative condition,Japanese Orthopaedic Association(JOA)score,visual analogue scale(VAS)score and postoperative complications of the 2 groups were recorded.Results The operation time and intraoperative blood loss were higher in the retention group than in the non-retention group,but the hospital stay was slightly less than non-retention group,and the differences were statistically significant(P<0.05).There was no significant difference between the 2 groups in laminoplasty opening angle and distance of spinal cord posterior drift(P>0.05).At the final follow-up,the loss of ROM was lower in the retention group than in the non-retention group,and the cervical curvature in the retention group maintained well,while the cervical curvature in the non-retention group was significantly lower than that before operation,both with a statistical significance(P<0.05).There was no significant difference in JOA score and improvement rate between the 2 groups(P>0.05);but the postoperative neck pain VAS score was lower in the retention group than in the non-retention group,and the improvement of neck pain VAS score was more significant in the retention group than in the nonretention group,with a statistical significance(P<0.05).There were no serious complications such as infection,re-closure and spinal cord injury in the 2 groups,but the incidence of axial symptoms was significantly lower in the retention group than in the non-retention group,with a statistical significance(10.7%vs.22.5%,P<0.05).Conclusion The effect of single-door laminoplasty with mini titanium plate fixation retaining hemilateral paraspinal muscle ligament complex in treatment of MCSM is similar to traditional operation,although the surgcial steps are increased,however,it is helpful to reduce the occurrence of axial symptoms and the loss of cervical curvature.