重建棘突肌肉韧带复合体椎管减压成形术治疗脊髓型颈椎病的临床研究

Clinical effect of laminoplasty through reconstruction of spinous process-muscle-ligament complex for cervical spondylotic myelopathy

目的探讨重建棘突肌肉韧带复合体椎管减压成形术对颈椎病的治疗效果。方法我院63例脊髓型颈椎病行颈后路椎管减压成形术的患者,其中33例行重建棘突肌肉韧带复合体椎管减压成形术,即重建组,30例行椎管单开门式减压成形术,即传统组。比较两组患者术前、术后3个月与1年的颈椎活动度、过屈位曲度、中立位曲度与过伸位曲度,颈部VAS疼痛、神经功能JOA评分,同时对比术中出血量、手术时间、术后轴性症状与C5神经根麻痹发生率。结果 2组患者术后的颈椎过屈位曲度、神经功能JOA评分、颈部VAS疼痛评分、过伸位曲度等与术前比较差异有统计学意义(P<0.05);颈部疼痛VAS评分、过屈位曲度、中立位曲度与活动度和过伸拉曲度方面、轴性症状和C5神经根麻痹发生率,重建组与传统组比较差异有统计学意义(P<0.05)。结论重建棘突肌肉韧带复合体椎管减压成形术能够很好的让神经症状趋于良好,同时维持其运动能力,可减少轴性症状的发生,并减少C5神经根麻痹症状发生率。

Objective To explore the clinical effect of the reconstruction of spinous process-muscle-ligament complex for cervical spondylotic myelopathy. Methods Selected 63 cases accepted cervical posterior cervical laminoplasty,33 cases in reconstruction group accepted spinous process-muscle-ligament complex,30 cases in tradition group accepted cervical posterior spinal canal single-door decompression laminoplasty.Compared the spinal canal activity,across bending curvature,neutral position curvature,hyperextension bit curvature,the score of VAS and JOA,bleeding volume,time of operation,axial symptom,incidence rate of C5 never root palsy of the two groups before operation,3 months and 1 year after operation. Results Compared with postoperation,the across bending curvature,the score of VAS and JOA and hyperextension bit curvature before operation of the two groups had significant difference(P<0.05).The score of VAS,across bending curvature,neutral position curvature,spinal canal activity,hyperextension bit curvature,axial symptom,incidence rate of C5 never root palsy between two groups had significant difference( P < 0. 05). Conclusion Spinous process-muscle-ligament complex can effectively improve the patients neurological symptoms,retain more ranges of motion of cervical vertebra and decrease the incidence of axial symptom and C5 never root palsy.