椎板切除术与椎板复位术对颈椎髓内肿瘤患者术后颈椎畸形发生的影响

Effect of laminectomy and laminoplasty on postoperative cervical deformity in patients with cervical intramedullary tumor

目的 探讨椎板切除术与椎板复位术对颈椎髓内肿瘤患者术后颈椎畸形发生的影响。方法 对2017年1月至2019年12月首都医科大学三博脑科医院脊柱脊髓中心诊治的颈脊髓髓内肿瘤患者77例的临床资料进行回顾性分析。依据手术方式将全部患者分为椎板切除组(37例)和椎板复位组(40例)。对两组患者病变所在节段分别行椎板切除术和椎板复位术。两组患者的性别、年龄、症状、症状持续时间、肿瘤类型、受累椎体数量、术前神经功能评分等临床资料差异无统计学意义。对两组患者术后神经功能评分和颈椎畸形发生率进行比较。颈椎畸形定义为颈椎出现反曲或颈椎侧弯或后凸角度≥10°。结果 椎板切除组和椎板复位组随访时间分别为32(IQR 24-50)个月和35(IQR 26-51)个月,差异无统计学意义(P>0.05)。两组患者术后神经功能改良McCormick评分(MMS)均为2(2-3)分。椎板切除组患者术后发生颈椎畸形14例(37.8%),包括颈椎侧弯3例(8.1%)、颈椎后凸10例(27.0%)和颈椎侧弯合并颈椎后凸1例(2.7%);椎板复位组患者发生颈椎畸形6例(15.0%),包括颈椎侧弯2例(5.0%)和颈椎后凸4例(10.0%);两组颈椎畸形发生率差异有统计学意义(P=0.022)。结论 采用椎板复位术治疗颈椎髓内肿瘤患者,术后颈椎畸形发生率较椎板切除术下降。对存在脊柱畸形潜在风险的颈椎髓内肿瘤患者应优先考虑行椎板复位术治疗。

Objective To evaluate the effect of laminectomy and laminoplasty on postoperative cervical deformity in patients with cervical intramedullary tumor.Methods Clinical data of 77 patients with cervical intramedullary tumors treated in the Spine Center of Sanbo Brain Hospital,Capital Medical University from January 2017 to December 2019 were analyzed retrospectively.According to the surgery,all the patients were divided into 2 groups:the laminectomy group(n=37)and the laminoplasty group(n=40).The gender,age,symptoms,duration of symptoms,tumor nature,number of affected vertebrae,preoperative neurological function of patients were summarized and compared between the 2 groups and no statistical significant defference was found(all P>0.05).The postoperative neurological function and occurrence of cervical deformity(angle of cervical deformity≥10°)were compared between the 2 groups.Results The follow-up duration was 32(IQR 24-50)months in the laminectomy group and 35(IQR 26-51)months in the laminoplasty group,and the defference was not statistically significant(P>0.05).Fourteen(37.8%)cases with cervical deformation occurred in the laminectomy group including 3(8.1%)cervical scoliosis,10(27.0%)cervical kyphosis and one(2.7%)combining cervical scoliosis and cervical kyphosis.Six(15%)casese with cervical deformation occurred in the laminoplasty group including 2(5.0%)cervical scoliosis and 4(10.0%)cervical kyphosis.The incidence of postoperative spinal deformity was significantly different between the 2 groups(P=0.022).Conclusion Laminoplasty may reduce the incidence of cervical deformity after tumor resection for patients with cervical intramedullary tumors and should be suggested in patients with high-potential of spinal deformity.