单开门椎管成形术与全椎板减压融合内固定术治疗脊髓型颈椎病的临床疗效比较  

COMPARISON OF EFFECTIVENESS BETWEEN LAMINOPLASTY AND LAMINECTOMY DECOMPRESSION AND FUSION WITH INTERNAL FIXATION FOR CERVICAL SPONDYLOTIC MYELOPATHY

作　　者：张杭[1] 孙天威[1] 卢守亮[1] 李清江[1] Sandip Kumar Yadav 

机构地区：[1]天津医科大学天津市人民医院脊柱外科,天津300070

出　　处：《中国修复重建外科杂志》2012年第10期1191-1196,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨颈后路单开门椎管成形术与全椎板减压侧块螺钉植骨融合内固定术治疗脊髓型颈椎病的临床疗效。方法 2006年9月-2009年9月,对143例多节段(≥3个)脊髓型颈椎病患者分别采用颈后路单开门扩大椎管成形术(A组,87例)及全椎板减压侧块螺钉植骨融合内固定术(B组,56例)治疗,两组患者性别、年龄、病程、病变分型、病变节段等一般资料比较差异均无统计学意义(P>0.05),具有可比性。随访观察并比较两组患者手术时间、术中出血量、术后神经功能恢复[采用日本骨科协会(JOA)17分评分法]及手术并发症发生情况,并对两组患者手术前后颈椎曲率指数(cervical curvature index,CCI)、颈椎活动度(range of motion,ROM)及颈肩部疼痛[采用疼痛视觉模拟评分(VAS)及颈椎功能障碍指数量表(NDI)评分]等指标进行评估。结果两组患者手术时间和术中出血量比较差异均无统计学意义(P>0.05)。两组患者均获随访,随访时间18～30个月,平均24个月。A、B组术后分别有4例(4.60%)和5例(8.93%)出现C5神经根麻痹症状,比较差异无统计学意义(χ2=0.475,P=0.482)。两组术后均无深部感染、假关节形成及螺钉松动需再手术等并发症发生。A组患者术后均无椎板再关门发生;B组患者末次随访时无螺钉脱出、断裂及继发神经损伤等发生。末次随访时A、B组分别有35例(40.23%)和11例(19.64%)有颈部轴性症状,比较差异有统计学意义(χ2=6.612,P=0.009)。两组患者术前JOA评分、CCI、颈椎ROM及VAS评分比较差异均无统计学意义(P>0.05);末次随访时两组JOA评分、颈椎ROM、VAS评分及A组CCI均较术前有显著改善(P<0.05)。末次随访时,A、B组间JOA评分及改善率、VAS评分比较差异均无统计学意义(P>0.05);A组ROM大于B组,CCI小于B组,差异有统计学意义(P<0.05);末次随访时NDI评分,A组在疼痛程度、上举能力、工作、驾车、反应及总分方面均显著优于B组(P<0.05Objective To compare the clinical and radiographic outcomes between laminoplasty and laminectomy compression and fusion with internal fixation to treat cervical spondylotic myelopathy. Methods Between September 2006 and September 2009, 143 cases of multilevel cervical myelopathy （the affected segments were more than 3） were treated by laminoplasty in 87 cases （group A） and by laminectomy decompression and fusion with lateral mass screw fixation in 56 cases （group B）. There was no significant difference in gender, age, disease duration, pathological type, and affected segments between 2 groups （P 〉 0.05）. The operation time, intraoperative blood loss, improvement of neurological function [Japanese Orthopaedic Association （JOA） 17 score], and the incidences of complications were observed; the cervical curvature index （CCI）, range of motion （ROM）, and symptoms of neck and shoulder pain [visual analogue scale （VAS） and neck disability index （NDI） scores] were recorded and compared. Results There was no significant difference in operation time and intraoperative blood loss between 2 groups （P 〉 0.05）. All patients were followed up 18-30 months （mean, 24 months）. C5 nerve root palsy occurred in 4 cases （4.60%） of group A and in 5 cases （8.93%） of group B, showing no significant difference （χ2=0.475, P=0.482）. No complication of deep infection, pseudarthrosis, or screw loosening occurred. No closure of opened laminae was observed in group A; and no screw extrusion, breakage, or nerve injury was observed in group B. At last follow-up, neck axial symptomsappeared in 35 cases （40.23%） of group A and in 11 cases （19.64%） of group B, showing significant difference （χ2=6.612, P=0.009）. No significant difference was found in JOA score, CCI, ROM, or VAS scores between 2 groups at preoperation （P 〉 0.05）; the IOA score, ROM, and VAS scores of groups A and B and CCI of group A at last follow-up were significantly improved when compared with preoperati

关 键 词：脊髓型颈椎病 单开门椎管成形术 全椎板减压融合 轴性症状 

分 类 号：R687.3[医药卫生—骨科学]