颈椎后路减压术后脊髓后移的临床意义  

Clinical significance of spinal cord shifting backward after cervical posterior decompression

作　　者：张为[1] 李鹏飞[1] 杨大龙[1] 李宝俊[1] 丁文元[1] 申勇[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》2011年第1期11-14,共4页Orthopedic Journal of China

摘　　要：[目的]探讨颈后路减压术后脊髓后移位对多节段脊髓型颈椎病（cervical spondylotic myelopathy,CMS）的临床意义。[方法]2003年7月~2008年6月,回顾性分析65例多节段脊髓型颈椎病患者,其中,男41例,女24例;年龄40~75岁,平均58.4岁。行颈后路单开门椎管成形减压术后通过MR I比较其术前及术后的脊髓后移位距离。根据患者术后脊髓后移位的距离不同将其分为三组（A≤2 mm;2 mm〈B〈4 mm;C≥4 mm）,对三组患者手术前后的JOA评分、颈椎曲度指数的丢失程度（curvature index,C I）及轴性症状（axial symptom,AS）的严重程度进行比较评估。[结果]随访时间24~55个月,平均31个月。JOA评分恢复率,A组患者为63.1%±16.9%,B组患者为59.5%±22.3%,C组患者为54.3%±9.8%,三组差异无统计学意义。A组患者术后颈椎曲度丢失指数为3.2%±2.4%,B组患者为3.1%±2.7%,C组为4.2%±3.1%,三组患者手术前后颈椎曲度的变化差异无统计学意义。A组术后有明显轴性症状患者的比例为18.2%,B组为36.7%,C组为53.8%,三组比较差异有统计学意义（P〈0.05）。[结论]颈后路椎板切除术后脊髓后移位程度与病人术后恢复程度无明显关联。脊髓后移距离与术后曲率指数亦无明显关联。脊髓后移位与术后轴性症状的程度存在相关性。[Objective]To investigate the clinical significance of posterior spinal cord shifting after cervical posterior decompression. [Methods]From July 2003 to June 2008,65 patients of cervical spondylotic myelopathy were reviewed in this study,which consisted of 41 male and 24 female patients.The mean age was 58.4 years（range,40~75）.All patients underwent open-door laminoplasty and the recovery rate was calculated using preoperative and postoperative JOA scores for each patient.Magnetic resonance imaging,the postoperative cervical curvature index and the magnitude of postoperative shifting backward of the spinal cord were also measured and compared.[Results]All patients were followed up for 24~55 months（average,31 months）.The average JOA recovery rate was 63.1%±16.9% for group A,59.5%±22.3% for group B and 54.3%±9.8% for group C.There was no significant difference in JOA recovery rate among the three groups.Loss of cervical curvature index was 3.2%±2.4% in group A,3.1%±2.7% in group B and 4.2%±3.1% in group C.There was no significant difference in loss of cervical curvature indices among the three groups.The rate of evident axial symptoms was 18.2% in group A,36.7% in group B and 53.8% in group C,and the difference was statistically significant（P0.05）.[Conclusion]The recovery rate and curvature index after posterior decompression surgery is not correlated with the distance backward shifting of the spinal cord,and no correlation was found between the curvature index and posterior shifting backward of the spinal cord.There is a correlation between axial symptom and posterior shifting backward of the spinal cord.

关 键 词：颈椎病 脊髓后移 椎板成形术 曲率指数 轴性症状 

分 类 号：R687.3[医药卫生—骨科学]