单开门椎管扩大成形术门轴侧椎板及侧块植骨治疗多节段脊髓型颈椎病的短期疗效

Short-term efficacy of single open-door laminoplasty and lateral mass bone grafting in the treatment of multilevel cervical spondylotic myelopathy

目的探讨颈后路单开门椎管扩大成形术门轴侧椎板及侧块植骨治疗多节段脊髓型颈椎病(CSM)的短期疗效。方法收集2021年1月至2022年12月郑州大学第一附属医院骨科收治的行C3-7单开门手术治疗的多节段CSM患者103例,将术中门轴侧未植骨者纳入对照组(53例),门轴侧椎板及侧块植骨者纳入改良组(50例)。记录并分析两组患者的一般资料、手术时间及术中失血量,术前、术后1年日本骨科协会(JOA)评分,术前、术后3个月、术后1年疼痛视觉模拟评分法(VAS)评分,术后颈椎失稳发生率,术后3、6个月椎体融合率,术后颈椎关节活动度(ROM)丢失角度(°),术后并发症发生率。计量资料均符合正态分布,组内和组间比较采用t检验、χ^(2)检验。结果对照组患者年龄、病程、手术时间、术中失血量[(62.17±6.62)岁、(12.74±5.60)月、(107.25±1.18)min、(217.28±41.73)ml]与改良组[(62.72±6.72)岁、(12.76±5.81)月、(108.70±8.11)min、(216.80±45.06)ml]比较,差异无统计学意义(F=0.019、0.022、0.007、0.115,P>0.05)。对照组和改良组患者术后1年JOA评分[(12.79±1.12)、(12.86±1.16)分]均优于术前[(6.47±0.95)、(6.30±1.06)分],差异有统计学意义(t=-48.122、-38.182,P<0.05)。对照组与改良组患者术后1年JOA评分改善率[(60.27±9.10)%比(61.21±9.44)%]比较,差异无统计学意义(F=0.213,P>0.05)。对照组和改良组患者术后1年VAS评分[(1.96±0.80)、(1.34±0.59)分]均优于术前[(5.89±1.25)、(5.92±1.14)分],差异有统计学意义(F=599.207、460.792,P<0.05)。对照组和改良组患者术前VAS评分[(5.89±1.25)分比(5.92±1.14)分]及术后3个月VAS评分[(3.58±1.15)分比(3.68±1.15)分]比较,差异无统计学意义(F=0.003、0.003,P>0.05)。术后1年VAS评分改良组(1.34±0.59)分优于对照组(1.96±0.80)分,差异有统计学意义(F=0.400,P<0.05)。术后1年,对照组颈椎失稳发生率(20.75%)高于改良组(8.00%),差异有统计学意义(χ^(2)=4.769,P<0.05)。改良组术后3、6个月门轴侧融合率(86.00%、93.60%)优于对照组(55.85%、76.23%),差异有统计学意义(χ^(2)=16.297、6.732,P<0.05)。术后1年,对照组与改良组ROM平均丢失角度[(9.81±1.44)°、(10.36±1.24)°]比较,差异无统计学意义(F=0.986,P>0.05)。对照组患者轴性症状发生率(28.30%)高于改良组(10.00%),差异有统计学意义(χ^(2)=5.509,P<0.05)。术后对照组门轴断裂发生率(1.89%)与改良组(0.00%)比较,差异无统计学意义(F=0.986,P>0.05)。结论门轴侧椎板及侧块植骨的改良颈后路单开门椎管扩大成形术治疗CSM临床效果满意,能较好地维持颈椎稳定性,降低术后轴性症状的发生。

Objective To investigate the short-term efficacy of posterior single-door laminoplasty and lateral mass bone grafting in the treatment of multilevel cervical spondylotic myelopathy(CSM).Methods From January 2021 to December 2022,103 patients with multi-level CSM who underwent C3-7 open-door surgery were collected in the Department of Orthopedic Surgery at the First Affiliated Hospital of Zhengzhou University.Patients with no supplemental bone graft on the axial side of the portal were enrolled in the control group(53 cases),while those with bone graft on the axial side of hinged side were enrolled in the modified group(50 cases).The demographic data,operative time and estimated blood loss during operation were recorded and analyzed.The JOA score was assessed before and 1 year after operation,the visual analogue scale(VAS),the incidence of postoperative cervical spine instability,the fusion rate at 3rd and 6th month postoperatively and,loss of postoperative cervical joint(ROM),postoperative complications were documented.The measurement data were normally distributed.Thet-test andχ^(2)test were used to compare within and between groups.Results There weres no significant differences in age,course of disease,operative time and blood loss during operation between the control group[(62.17±6.62)years,(12.74±5.60)months,(107.25±1.18)min,(217.28±41.73)ml]and the improved group[(62.72±6.72)years,(12.76±5.81)months,(108.70±8.11)min,(216.80±45.06)ml](F=0.019,0.022,0.007,0.115,P>0.05).The JOA scores after operation in the control group and the modified group(12.79±1.12,12.86±1.16)were significantly higher than those preoperation[(6.47±0.95,6.30±1.06),t=-48.122,-38.182,P<0.05].There was no significant difference in the improvement rate of JOA score between the control group and the modified group[(60.27±9.10)%,(61.21±9.44)%,F=0.213,P>0.05].The VAS scores in the control group and the modified group were(1.96±0.80)and(12.86±1.16)respectively one year after operation,which were significantly higher than those before operation[(5.89±1.25)and(5.92±1.14),F=599.207,460.792,P<0.05].Between the control group and the improved group,there was no significant difference in VAS score before operation(5.89±1.25 and 5.92±1.14)and at 3rd month after operation(3.58±1.15 and 3.68±1.15,F=0.003,0.003,P>0.05).One year after operation,the VAS score in the improved group(1.34±0.59)was significantly better than that in the control group(1.96±0.80,F=0.400,P<0.05).At first year after operation,the incidence of cervical instability in the control group(20.75%)was higher than that in the modified group(8.00%,χ^(2)=4.769,P<0.05).The axial fusion rate of the modified group at 3rd and 6th month after operation(86.00%,93.60%)was higher than that of the control group(55.85%,76.23%χ^(2)=16.297,6.732,P<0.05).At first year after operation,there was no significant difference in the mean angle of ROM loss between the control group and the modified group[(9.81±1.44)°,(10.36±1.24)°,F=0.986,P>0.05].The incidence of axial symptoms in the control group(28.30%)was significantly higher than that in the modified group(10.00%,χ^(2)=5.509,P<0.05).There was no significant difference in the incidence of portal shaft rupture between the control group(1.89%)and modified group(0.00%,F=0.986,P>0.05).Conclusion The modified unilateral open-door laminoplasty,with lateral mass and facet joint grafting,demonstrates satisfactory clinical outcomes in treating CSM.It effectively maintains cervical spine stability and reduces the occurrence of postoperative axial symptoms.