保留颈半棘肌肌止的椎板成形术的临床应用  

Clinical application of the modified open-door laminoplasty perserving semispinalis cervicis insert into axis

作　　者：张为[1] 董玉昌[1] 申勇[1] 丁文元[1] 张标[1] 李宝俊[1] 姚晓光[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄050051

出　　处：《中国矫形外科杂志》2006年第13期980-982,共3页Orthopedic Journal of China

摘　　要：[目的]研究确定行颈椎单开门椎板成形术时完整保留C2颈半棘肌肌止是否能有效维持颈椎术后矢状序列,降低术后颈椎轴性症状的发生。[方法]2002年3月～2003年12月,本院行保留颈半棘肌肌止的椎板成形术48例,其中32例获得至少2a的随访列为试验组,对患者术前、术后的JOA评分、颈椎轴性症状严重程度、颈椎曲度指数、颈椎活动度进行比较评估。[结果]本组患者术前、术后JOA评分分别为(9.0±2.9)和(12.5±3.1),恢复率(44.9±26.9)。手术前、后有明显症状颈椎轴性症状的患者比例分别为46.8%和18.7%,差别有统计学意义(P<0.05)。手术前后患者颈屈指数、颈椎活动范围等指标无统计学意义差别。[结论]保留颈半棘肌肌止的椎板成形术可以减少对颈椎后伸机理的破坏,有效维持术后颈椎矢状序列减少轴性症状的发生。[ Objective] To verify whether or not the modified open-door laminoplasy preserving semispinalis cervicis insert into axis is effective in preventing postoperative axial symptom and maintaining postoperative cervical sagittal alignment. [Method ] Since March 2002 to December 2003, forty-eight patients underwent modified open-door laminoplasy preserving semispinalis cervicis insert into Axis, among them, thirty-two patients who were followed up for more than 2 years were included in this study. Preoperative and postoperative JOA score, degree of axial symptom, ranges of neck motion, cervical curvature index were recorded and compared. [ Result ] Preoperative and postoperative JOA score was （9. 04 ± 2. 9） and （ 12. 5 ± 3. 1 ） respectively, with recovery rate as （44. 9 ± 26. 9）. There was significant difference between preoperative evident axil symptom rate （46. 8% ） and postoperative evident axil symptom rate （18. 7% ）, while no significant difference between preoperative and postoperative ranges of neck motion, cervical curvature index was seen. [ Conclusion ] Modified open-door laminoplasy is less invasive to the posterior extensor mechanism especially the semispinalis cervicis than conventional open-door laminoplasy. This new procedure is effective in preventing postoperative morbidities often seen after conventional laminoplasy with adequate decompression of the spinal cord.

关 键 词：颈椎管狭窄 颈半棘肌 矢状序列 轴性症状 椎板成形术 

分 类 号：R687.3[医药卫生—骨科学]