单开门术后前方残留压迫阻碍神经功能恢复的研究  

Study on residual anterior cord compression after laminoplasty inhibiting neurologic recovery

作　　者：袁泉[1] 杨惠林[1] 陈广东[1] 刘凌[1] 朱若夫[1] 陈超[1] 沈敏杰[1] 王治栋[1] 

机构地区：[1]苏州大学附属第一医院骨外科,苏州市十梓街188号215006

出　　处：《中国矫形外科杂志》2013年第3期228-232,共5页Orthopedic Journal of China

摘　　要：[目的]研究后路单开门成形术后脊髓前方残留压迫对神经功能恢复的影响,并探讨残留压迫与术前椎管侵占率以及致压物最大径之间的关系。[方法]2008年1月～2010年12月在本院行单开门手术的脊髓型颈椎病患者60例,所有患者均获得随访。平均随访时间34个月(12～52个月)。将患者分为两组,A组:22例术后存在前方残留压迫;B组:38例术后不存在前方残留压迫。比较和分析两组术后疗效及影像学资料,如JOA总体评分及改善率,JOA各项评分及改善率,术前及术后颈椎曲度,前方压迫物最大径以及椎管侵占率。[结果]两组平均年龄、病程、随访时间、术前JOA评分以及术前术后的颈椎曲度比较均无统计学差异(P>0.05)。A组JOA改善率(52.7±19.2)%,B组改善率(69.8±9.8)%,两组间改善率比较有统计学差异(P<0.05),A组vs B组上肢运动功能改善率(44.6%vs76.3%),下肢运动功能改善率(43.2%vs57.2%),两组间比较有统计学差异(P<0.05)。A组压迫物最大径及椎管侵占率分别为(7.2±1.4)mm和(58.2±10.7)%,B组分别为(5.9±1.3)mm和(49.5±10.6)%,两组间比较有统计学差异(P<0.05)。[结论]单开门术后脊髓受到前方残留压迫时会阻碍神经功能的恢复,特别是在四肢运动功能方面。单开门手术对伴有前方巨大占位的脊髓型颈椎病的治疗具有局限性。[ Objective] To investigate how neurologic recovery is influenced by residual anterior cord compression after laminoplasty and the relationship between residual compression and maximal thickness of compressive mass and occupying rate. [Methods] From January 2008 to December 2010, sixty consecutive patients who underwent expansive laminoplasty for the treatment of cervical spondylotic myelopathy at our hospital were reviewed. All 60 patients were available for follow - up. The average follow- up period were 34 months （12 -52 months） . Patients were divided into 2 groups： group A： 22 patients who had residual anterior cord compression; group B： 38 patients who had no residual anterior cord compression. Clinical outcome and ra- diologic evaluation, such as mean total JOA score and recovery rate, mean JOA score of each item and recovery rate, preopera- tive and postoperative curvature angle, maximal thickness of compressive mass and occupying rate, were compared between the two groups. [ Results ] There were no significant differences with regard to mean age, duration of symptom, follow - up period, pre - JOA score, preoperative and postoperative curvature angle between the two groups （P 〉 0. 05） . The recovery rate of JOA scores was （52. 7± 19. 2）% in group A and （69. 8 ± 9. 8 ）% in group B, which showed significant differences between two groups （P 〉0. 05） . Group A vs group B in recovery rate of upper extremity motor function （44. 6% vs 76. 3% ） and in lower extremity motor function （43.2% vs 57.2% ） were found, there was significant difference between two groups. Maximal thickness of compressive mass and occupying rate was （7. 2 ± 1.4） mm and （58. 2 ± 10. 7） % in group A and （5.9 ± 1.3 ） mm and （49. 5 ± 10. 6） % in group B, a significant difference were found between the two groups （P 〈0. 05） . [ Conclusion] Neurologic recovery is inhibited by residual anterior cord compression after laminoplasty, especially in the upper or lower extremity motor fu

关 键 词：脊髓型颈椎病 单开门椎管扩大椎板成形术 椎管侵占率 前方残留压迫 

分 类 号：R687.3[医药卫生—骨科学]