颈椎后路C3~6与C3~7单开门椎管扩大成形术对颈椎矢状面参数的影响

Effects of posterior C3-6 and C3-7 expansive open-door laminoplasty on cervical sagittal parameters

目的:比较颈椎后路C3~6与C3~7单开门椎管扩大成形术治疗颈椎椎管狭窄症术后颈椎矢状面参数的差异。方法:回顾性选取2016年1月至2021年6月南昌大学第一附属医院收治的65例患有颈椎椎管狭窄症的患者作为研究对象。根据患者所行手术方式的不同分为颈椎后路C3~6单开门组(37例)和C3~7单开门组(28例)。记录并比较两组患者的围手术期指标。所有患者随访时间≥1年,术前1 d、术后3 d及术后1年观察并比较两组患者的临床疗效、颈椎矢状面参数、各颈椎节段Pavlov比值及减压程度。观察两组患者术后并发症发生情况。结果:C3~6单开门组患者的手术时间短于C3~7单开门组,术后引流量少于C3~7单开门组,拔管时间早于C3~7单开门组,差异均有统计学意义(P均<0.05)。术后3 d和术后1年时,两组患者的日本骨科协会(JOA)评分、疼痛视觉模拟评分(VAS)均高于本组术前,差异均有统计学意义(P均<0.05)。术后3 d及术后1年时,C3~7单开门组的T1倾斜角均大于C3~6单开门组,差异均有统计学意义(P均<0.05);术后1年,C3~7单开门组的C2~7 Cobb角大于C3~6单开门组,差异有统计学意义(P<0.05)。术后3 d及术后1年时,两组患者各颈椎节段Pavlov比值均大于术前1 d,差异均有统计学意义(P均<0.05)。两组患者各颈椎节段减压程度和术后并发症总发生率比较,差异均无统计学意义(P均>0.05)。结论:颈椎后路C3~6单开门与C3~7单开门椎管扩大成形术比较,手术时间更短,术后引流量更少,拔管时间更早,术后T1倾斜角更小,且对颈椎后方肌肉韧带复合体的损伤更小,颈椎后凸畸形发生率也更低,有助于促进患者早日康复,提高患者满意度。

Objectives:To compare cervical sagittal parameters after posterior cervical C3-6 versus C3-7 expansive open-door laminoplasty for cervical spinal stenosis.Methods:This retrospective study included 65 patients with cervical spinal stenosis treated at the First Affiliated Hospital of Nanchang University from January 2016 to June 2021.Patients were divided into two groups based on the surgical approach:the C3-6 single-door group(37 cases) and C3-7 single-door group(28 cases).Perioperative indicators were recorded and compared between the two groups.All patients were followed for at least one year.Clinical outcomes,cervical sagittal parameters,Pavlov ratios at each cervical segment and the degree of decompression were assessed and compared at days 1 and 3 and 1year postoperatively.Postoperative complications were also observed in both groups.Results:The C3-6 single-door group had a significantly shorter surgical duration,less postoperative drainage,and earlier extubation time compared to the C3-7 single door group(all P<0.05).Both groups showed significantly improvements in the JOA and VAS scores at 3 days and 1 year postoperatively compared to baseline(all P<0.05).At both follow-up points,the T1 tilt angle angle in the C3-7 single-door group was significantly greater than that in the C3-6 single-door group(all P<0.05).At 1 year postoperatively,the C2-7 Cobb was significantly greater in the C3-7 single-door group than in the C3-6 single-door group(P<0.05).At 3 days and 1 year postoperatively,Pavlov ratios at each cervical segment improved significantly in both groups compared to baseline(all P<0.05).There were no statistically significant differences in the degree of decompression at each cervical segment or postoperative complication rates between the two groups(all P>0.05).Conclusions:Compared to posterior cervical C3-7 expansive open-door laminoplasty,the C3-6 expansive open-door laminoplasty resulted in a shorter surgical duration,less postoperative drainage,earlier extubation time,smaller postoperative T1 tilt angle,less damage to the posterior cervical muscle-ligament complex,and a lower incidence of cervical kyphosis,promoting faster recovery and higher patient satisfaction.