三种改良颈后路通道辅助下椎管扩大椎板成形术治疗颈椎退行性疾病的疗效比较

Comparison of effectiveness between three modified channel-assisted laminoplasty for the treatment of cervical degenerative diseases

目的:与常规颈后路椎管扩大椎板成形术对比,探讨三种改良的颈后路通道辅助下椎管扩大椎板成形术的临床效果。方法:回顾性分析2020年10月~2022年10月共122例行颈后路椎管扩大椎板成形术的患者资料,其中27例患者接受了颈后路双侧通道辅助下椎管扩大椎板成形术,纳入双侧通道组(bilateral channelassisted laminoplasty,BCA组);31例患者接受开门侧肌间隙入路+铰链侧通道辅助下椎管扩大椎板成形术,纳入肌间隙入路+单侧通道组(inter-muscular approach and unilateral channel-assisted laminoplasty,IM-UCA组);34例患者接受开门侧常规显露+铰链侧通道辅助下椎管扩大椎板成形术,纳入单侧通道组(unilateral channel-assisted laminoplasty,UCA组);30例患者接受常规的椎管扩大椎板成形术,纳入常规组(laminoplasty,LP组)。四组患者的年龄、性别、身体质量指数(body mass index,BMI)及诊断无统计学差异(P>0.05)。记录并比较四组患者手术时间、出血量、术后引流量、平均住院日。于术前、术后即刻、术后2个月、12个月及末次随访时采用视觉模拟量表(visual analogue scale,VAS)评分评估颈部疼痛程度、颈椎功能障碍指数(neck disability index,NDI)评价患者颈椎功能、日本骨科协会(Japanese Orthopaedic Association,JOA)评分评估神经功能状况。四组间术前VAS评分、NDI及JOA评分的差异无统计学意义(P>0.05)。于术前、术后即刻、术后2个月、12个月及末次随访时在颈椎侧位X线片上测量C2~C7 Cobb角、T1倾斜角、C2~C7矢状位偏移(C2~C7 SVA)、CT横断面上测量骨性椎管面积,比较不同手术方法上述指标的组间差异。结果:所有患者均顺利完成手术。手术时间LP组与UCA组比较没有显著性差异(P>0.05),IM-UCA组较LP组更长,BCA组最长(P<0.05)。四组间术中出血量及术后引流量BCA组最少,IM-UCA组与UCA组次之(两组比较无显著性差异,P>0.05),LP组最多。四组间平均住院天数差异无统计学意义(P>0.05)。四组患者术后NDI及JOA评分均较术前有明显改善(P<0.05),四组间术后即刻、术后2个月、12个月及末次随访时的NDI及JOA评分的差异无统计学意义(P>0.05)。LP组术后即刻、术后12个月及末次随访时的颈痛VAS评分与术前比较,差异有统计学意义(P<0.05),术后2个月的颈痛VAS评分与术前比较无显著性差异(P>0.05)。UCA组、BCA组、IM-UCA组的术后即刻颈痛VAS评分与术前比较无显著性差异(P>0.05),三组术后2个月、术后12个月及末次随访时的颈痛VAS评分与术前比较,差异均有显著性差异(P<0.05)。LP组术后12个月及末次随访时的C2~C7 Cobb角较术前有显著性差异(P<0.05),四组间术前、术后即刻、术后2个月的C2~C7 Cobb角无显著性差异(P>0.05),四组间术后12个月、末次随访时的C2~C7 Cobb角差异有显著性差异(P<0.05)。四组术后即刻、术后2个月、12个月及末次随访时T1倾斜角、C2~C7 SVA均较术前无显著性差异(P>0.05),四组间术前、术后即刻、术后2个月、12个月及末次随访时的T1倾斜角、C2~C7 SVA比较无显著性差异(P>0.05)。四组术后即刻、术后2个月、12个月及末次随访时的椎管面积增加程度比较无显著性差异(P>0.05),四组间术前、术后即刻、术后2个月、12个月及末次随访时的椎管面积增加程度比较无显著性差异(P>0.05)。结论:与LP组相比较,UCA组能显著减少手术创伤;与IM-UCA组、BCA组相比较,UCA组显著减少手术时间,疗效满意。

Objectives:Comparing with traditional open-door laminoplasty,to explore the clinical effects of three modified channal-assisted laminoplasty for the treatment of cervical degenerative diseases.Methods:The data of 122 patients who underwent open-door laminoplasty from October 2020 to October 2022 were retro-spectively analyzed.27 patients who underwent bilateral channel-assisted laminoplasty were defined as BCA group;31 patients who underwent unilateral inter-muscular approach and unilateral channel-assisted lamino-plasty were defined as IM-UCA group;34 patients who underwent unilateral exposure and unilateral channelassisted laminoplasty were defined as UCA group;30 patients underwent traditional open-door laminoplasty were defined as LP group.There were no significant differences in age,sex,body mass index(BMI)and diag-nosis between the 4 groups(P>0.05).Surgical parameters such as the operative time,blood loss,postoperative drainage volume,and average length of stay were compared.Clinical parameters such as visual analogue scale(VAS)score of neck pain,neck disability index(NDI),Japanese Orthopaedic Association(JOA)score were all recorded and compared.There was no statistical difference between the 4 groups in preoperative VAS,NDI,and JOA score(P>0.05).The C2-C7 Cobb angle,T1 slope,C2-C7 sagittal vertical axis(C2-C7 SVA)were measurement on lateral cervical X-rays and bone canal area on CT cross-section before surgery,immediately after surgery,2 months and 12 months after surgery,and at final follow-up.The differences in the above pa-rameters between the three surgical methods were compared.Result:All the patients underwent the operation successfully.The LP group and UCA group weren′t statistically different in the operative time(P>0.05),while the IM-UCA group was longer,and the BCA group was the longest(P<0.05).The BCA group had the least intraoperative blood loss and postoperative drainage,followed by the IM-UCA group and the UCA group(no difference between the two groups,P>0.05),and the LP group had the most blood loss and drainage.There was no statistically significant difference in the average length of hospital stay among the 4 groups(P>0.05).The postoperative scores of NDI and JOA in the 4 groups were significantly improved compared with those before operation(P<0.05).There was no statistically significant difference in NDI and JOA scores among the 4 groups immediately after surgery,2 months after surgery,12 months after surgery,and at final follow-up(P>0.05).In the LP group,there were significant differences in the neck pain VAS scores immediately after surgery,12 months after surgery,and at final follow-up compared with before surgery.There was no differ-ence in the neck pain VAS scores 2 months after surgery compared with before surgery(P>0.05).In the UCA group,BCA group,and IM-UCA group,the neck pain VAS scores of immediate postoperation were similar with the values before surgery(P>0.05).The neck pain VAS scores in the 3 groups at 2 months after surgery,12 months after surgery and final follow-up were significantly different from those before surgery(P<0.05).The C2-C7 Cobb angle in the LP group at 12 months after surgery and final follow-up showed significant differ-ences compared with those before surgery(P<0.05).There was no difference in C2-C7 Cobb angle among the 4 groups before surgery,immediately after surgery,or 2 months after surgery(P>0.05).There were significant differences in C2-C7 Cobb angle among the 4 groups at 12 months after surgery and final follow-up(P<0.05).In the 4 groups,compared with before surgery,there was no difference in T1 slope and C2-7 SVA levels immediately after surgery,2 months after surgery,12 months after surgery,and final follow-up(P>0.05).There was no difference in C2-C7 Cobb angle between the 4 groups immediately after surgery,2 months after surgery,12 months after surgery,and at final follow-up(P>0.05).In the 4 groups,there was no difference in the increased cross-sectional area of spinal canal immediately after surgery,2 months after surgery,12 months after surgery,and final follow-up(P>0.05).There was no difference in the increased cross-sectional area of spinal canal among the 4 groups before surgery,immediately after surgery,2 months after surgery,12 months after surgery,and final follow-up(P>0.05).Conclusions:Compared with the LP group,the UCA group significantly reduced surgical trauma;Compared with the IM-UCA group and BCA group,the UCA group sig-nificantly reduced operative time,and the therapeutic effect of UCA laminoplasty was satisfactory.