颈椎后路单侧显露通道辅助下椎管扩大椎板成形术治疗颈椎退行性疾病

Treatment of cervical degenerative disease with unilateral exposure and channel assisted laminoplasty

目的 评价颈椎后路单侧显露通道辅助下椎管扩大椎板成形术治疗颈椎退行性疾病的临床效果。方法2020年9月—2021年11月,采用椎管扩大椎板成形术治疗颈椎退行性疾病患者64例,其中36例采用颈椎后路单侧显露通道辅助进行手术(通道组),28例采用传统后路进行手术(对照组)。记录2组患者手术时间、住院时间、术中出血量、术后引流量等指标及并发症发生情况。于术前、术后即刻、术后2个月及末次随访时采用疼痛视觉模拟量表(VAS)评分评估颈部和上肢疼痛程度,采用颈椎功能障碍指数(NDI)和日本骨科学会(JOA)评分评估神经功能状况。结果 所有手术顺利完成。所有患者随访3 ~ 16个月,平均7.8个月。术后未发生神经损伤、感染等并发症。2组手术时间、住院时间差异无统计学意义(P > 0.05)。通道组术中出血量和术后引流量均明显小于对照组,差异有统计学意义(P < 0.05)。末次随访时2组颈痛VAS评分均较术前显著改善,且术后即刻、术后2个月通道组颈痛VAS评分低于对照组,差异均有统计学意义(P < 0.05)。2组术后各时间点上肢痛VAS评分、NDI及JOA评分均较术前明显改善,差异有统计学意义(P < 0.05);各时间点组间差异无统计学意义(P > 0.05)。结论 与常规术式相比,颈椎后路单侧显露通道辅助下椎管扩大椎板成形术能有效减轻铰链侧肌肉和韧带损伤,减少术中出血量、术后引流量及降低术后早期轴性颈痛发生率。

Objective To evaluate the clinical effect of unilateral exposure and channel assisted laminoplasty in the treatment of cervical degenerative disease.Methods From September 2020 to November 2021,64 patients with cervical degenerative diseases were treated by laminoplasty.Among them,36 patients were operated with unilateral exposure and channel assisted(channel group),and 28 patients were operated via traditional posterior approach (control group).Operation time,hospital stay,intraoperative blood loss,postoperative drainage volume and complications were recorded in 2 groups.At preoperation,immediately postoperative,postoperative 2 months and the final follow-up,the visual analogue scale(VAS) score was used to evaluate the intensity of pain in the neck and upper limbs,neck disability index(NDI) and Japanese Orthopedic Association(JOA) score were used to evaluate the neurological function.ResultsAll the operations were successfully completed.Patients were followed up for 3-16 months,with an average of 7.8 months.No postoperative complications such as nerve injury and infection occurred.There was no significant difference in operation time and hospital stay between the 2 groups(P > 0.05).The intraoperative blood loss and postoperative drainage volume in the channel group were significantly lower than those in the control group,all with a statistical difference(P < 0.05).At the final follow-up,the VAS scores of neck pain in the 2 groups were significantly improved compared with those before operation,and the VAS scores of neck pain in the channel group immediately after operation and at postoperative 2 months were lower than those in the control group(P < 0.05).The VAS score of upper limb pain,NDI and JOA score of the 2 groups were significantly improved at each time point after operation,all with a statistical significance(P < 0.05);but there was no significant difference between the 2 groups at each time point(P > 0.05).Conclusion Compared with traditional operation,unilateral exposure and channel assisted laminoplasty can effectively relieve the muscle and ligament injury at the hinge side,reduce intraoperative blood loss and postoperative drainage volume,the incidence of early postoperative axial neck pain.