颈后路双开门椎管扩大成形术后颈托外固定效果的前瞻性随机对照研究

The effect of cervical collar external fixation after posterior cervical double-door laminoplasty:A prospective randomized controlled trial

目的:探讨颈后路双开门椎管扩大成形术后佩戴颈托外固定对临床结果的影响,为脊柱外科加速康复管理提供循证和指导依据。方法:选取2022年1月至2023年7月于北京积水潭医院脊柱外科接受颈椎后路双开门椎管扩大成形术的100例患者作为研究对象,按照随机数字表法分为不佩戴颈托组(50例)和佩戴颈托组(50例)。不佩戴颈托组患者术后全程不佩戴颈托进行日常生活,佩戴颈托组患者术后佩戴颈托2周进行日常生活。于术前、术后3个月和术后6个月评价两组患者术后轴性症状发生情况、颈椎疼痛视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)、日本骨科协会(JOA)评分、颈椎活动度(ROM)、颈椎曲度及不良事件发生情况。结果:术后3个月和术后6个月,不佩戴颈托组患者轴性症状发生率与佩戴颈托组比较,差异均无统计学意义(P均>0.05)。时间因素对颈椎VAS评分、JOA评分、NDI、颈椎ROM、颈椎曲度的影响均有统计学意义(P均<0.001)。术后3个月和术后6个月,两组患者颈椎VAS评分、NDI均低于术前,JOA评分均高于术前,颈椎ROM、颈椎曲度均小于术前,差异均有统计学意义(P均<0.001)。术后3个月和术后6个月,两组患者颈椎VAS评分、JOA评分、NDI、颈椎ROM、颈椎曲度比较,差异均无统计学意义(P均>0.05);术后3个月和术后6个月,两组患者JOA评分改善率比较,差异均无统计学意义(F=1.008,P=0.271;F=4.091,P=0.484)。结论:颈后路双开门椎管扩大成形术后佩戴颈托与不佩戴颈托的临床结果相似。术后使用颈托并不会增加患者的轴性症状发生率,对患者的VAS评分、JOA评分、NDI、颈椎ROM、颈椎曲度及不良事件发生情况等方面均无显著影响。

Objective:To investigate the effect of cervical collar external fixation on clinical outcomes after posterior cervical double-door laminoplasty,and to provide evidence-based guidance for accelerated rehabilitation in spine surgery.Methods:A total of 100 patients who underwent posterior cervical double-door laminoplasty in the Department of Spine Surgery,Beijing Jishuitan Hospital from January 2022 to July 2023 were included.Using the random number table method,the participants were divided into the non-collar group(50 patients)and the collar group(50 patients).The patients in the non-collar group did not wear a neck collar postoperatively,while patients in the collar group wore a collar for 2 weeks postoperatively during daily activities.Postoperative axial symptoms,visual analogue scale(VAS)scores of cervical pain,Neck Disability Index(NDI),Japanese cervical Japanese Orthopedics Association(JOA)scores,cervical range of motion(ROM)scores,cervical curvature,and complications were evaluated before and after surgery at 3 months and 6 months in the two groups.Results:There was no significant difference in the incidence of axial symptoms between the two groups at 3 and 6 months postoperatively(all P>0.05).Statistically significant improvements were observed over time for the cervical VAS score,JOA score,NDI,cervical ROM,and cervical curvature(all P<0.001).At 3 months and 6 months postoperatively,both groups showed reduced cervical VAS and NDI,increased JOA scores,and decreased ROM and cervical curvature compared to preoperative values(all P<0.001).There was no significant difference in the cervical VAS score,JOA score,NDI,cervical ROM,or cervical curvature between the two groups(all P>0.05).There was no significant difference in the JOA improvement rate between the two groups at 3 months and 6 months postoperatively(F=1.008,P=0.271;F=4.091,P=0.484).Conclusions:Clinical outcomes of wearing a cervical collar after posterior cervical double-door laminoplasty were similar to those of not wearing a cervical collar.Routine use of a cervical collar after surgery does not increase the incidence of axial symptoms in patients,and has no significant effect on patients'VAS score,JOA score,NDI,cervical ROM,cervical curvature,or complications.