改良颈后路单开门椎板成形术治疗多节段脊髓型颈椎病的效果

Effect of modified posterior single door laminoplasty in treatment of multilevel cervical spondylotic myelopathy and its influence on ROM and cervical curvature

目的探讨改良颈后路单开门椎板成形术治疗多节段脊髓型颈椎病(cervical spondylotic myelopathy,CSM)的疗效。方法选择深圳市龙华区中心医院脊柱关节外科2014年1月1日~2019年6月1日收治的多节段CSM患者84例,按照随机数字表法分为两组,每组42例,对照组接受传统的颈后路单开门椎板成形术,观察组接受改良颈后路单开门椎板成形术。比较两组术后椎板开门角度和脊髓向后漂移距离,比较两组术前及术后12个月时颈椎活动度(range of motion,ROM)、颈椎曲度、日本骨科学会(Japanese orthopaedic association,JOA)评分、颈部功能障碍指数(neck dysfunction index,NDI),并比较两组轴性症状发生率。结果术后12个月,观察组颈椎ROM、颈椎曲度均显著大于对照组(P<0.05),JOA评分显著高于对照组(P<0.05),NDI评分显著低于对照组(P<0.05);观察组轴性症状发生率显著低于对照组(P<0.05)。结论改良颈后路单开门椎板成形术的脊髓减压疗效优于传统手术方式,对颈椎ROM、颈椎曲度影响小,轴性症状发生率低。

Objective To investigate the effect of modified posterior cervical laminoplasty in the treatment of multilevel cervical spondylotic myelopathy(CSM).Methods A total of 84 patients with multi segmental CSM in our hospital from January 1,2014 to June 1,2019 were selected and divided into two groups according to the random number table method,with 42 cases in each group.The control group were treated with traditional posterior cervical laminoplasty,and the observation group with modified posterior cervical laminoplasty.The open angle of vertebral lamina and the backward drift distance of spinal cord were compared between the two groups.The range of motion of cervical spine(ROM),cervical curvature,Japanese Orthopaedic Society(JOA)score and neck dysfunction index(NDI)score were compared before and 12 months after operation,and the incidence of axial symptoms was compared between the two groups.Results ROM and cervical curvature of the observation group were higher than those of the control group 12 months after operation(P<0.05),JOA score was higher than that of the control group(P<0.05),and NDI score was lower than that of the control group(P<0.05);the incidence of axial symptoms of the observation group was lower than that of the control group(P<0.05).The difference was statistically significant.Conclusion The modified posterior cervical laminoplasty is superior to the traditional operation in spinal cord decompression,with less influence on ROM and cervical curvature and low incidence of axial symptoms.