颈椎病单开门椎板成形术中是否切除C_(3)椎板

Unilateral open-door laminoplasty for multiple cervical myelopathies with or without C_(3) total laminectomy

[目的]比较颈椎后路单开门椎板成形术中切除与保留C_(3)椎板治疗多节段脊髓型颈椎病的临床效果。[方法]2018年1月-2019年12月,对56例多节段脊髓型颈椎病患者行后路单开门椎板成形术,其中,31例术中切除C_(3)椎板(切除组),25例术中保留C_(3)椎板(保留组)。比较两组患者围手术期、随访与影像资料。[结果]切除组手术时间显著少于保留组(P<0.05),但两组间术中出血量、术后引流量和平均住院时间的差异无统计学意义(P>0.05)。随时间推移,两组患者J0A评分显著增加(P<0.05),而VAS评分显著减少(P<0.05)。术前和术后3个月,两组间的J0A与VAS评分的差异无统计学意义(P>0.05),但是,末次随访时,切除组的J0A和VAS评分均显著优于保留组(P<0.05)。影像方面,与术前相比,末次随访时两组患者C_(2-7) Cobb角无显著变化(P>0.05),切除组C_(2-7)矢状垂线(sagittal vertical axis,SVA)无显著变化(P>0.05),而保留组C_(2-7)SVA显著增加(P<0.05)。末次随访时,切除组的C_(2-7)SVA显著小于保留组(P<0.05)。[结论]单开门椎板成形术中C_(3)椎板切除能够增加颈椎的前向稳定性,减小传统术式对颈椎矢状面力线的影响。

[Objective]To compare the clinical consequences of the unilateral open-door laminoplasty with or without C_(3) total laminoplasty for multi-segment cervical myelopathy.[Methods]From January 2018 to December 2019,a total of 56 patients underwent posterior unilateral open-door laminoplasty for multi-segment cervical myelopathy in our hospital.Among them,31 patients had C_(3) laminectomy conducted during the operation(the LE group),while 25 patients had C3 lamina preserved(the LP group)in the operation.The patients in the two groups were compared regarding to the documents of perioperative period,follow-up and radiographs.[Results]The LE group consumed significantly less operation time than the LP group(P<0.05),nevertheless,no statistically significant differences were noted in blood loss,postoperative drainage and average hospital stay between the two groups(P>0.05).The JOA score increased significantly(P<0.05),while the VAS score decreased significantly in both groups over time(P<0.05).Although there were no significant differences between the two groups in term of JOA and the VAS scores before operation and at 3 months after operation(P>0.05),the LE group proved significantly superior to the LP group in the abovesaid scores(P<0.05).With respect to the radiographic assessment,the C_(2-7) Cobb angles remained unchanged in both groups at the latest follow-up compared those before operation(P>0.05).However,the C_(2-7) sagittal vertical axis(SVA)was not significantly changed in the LE group(P>0.05),whereas significantly increased in the LP group at the latest follow-up compared with that preoperatively(P>0.05).The LE group had significantly less C_(2-7) SVA than the LP group at the last check(P<0.05).[Conclusion]The C_(3) laminectomy in unilateral open-door laminoplasty might improve the cervical anterior stability and reduce the impact of traditional technique on the cervical sagittal alignment.