3种颈椎后路单开门椎管扩大成形术的临床效果评价  

Evaluation of the clinical effect of three kinds of cervical unilateral open-door laminoplasty in posterior access

作　　者：卫秀洋[1] 陈勇忠[1] 王金星[1] 付桂红 

机构地区：[1]中国人民解放军第四七六医院,福建福州350002 [2]贵州省骨科医院,贵州贵阳550001

出　　处：《中医正骨》2014年第12期19-24,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：南京军区医学科技创新课题(11MB028)

摘　　要：目的:观察3种颈椎后路单开门椎管扩大成形术的临床疗效和安全性。方法:回顾性分析105例多节段颈段脊髓受压患者的病例资料,采用单开门丝线悬吊椎管扩大成形术治疗者35例(丝线固定组),采用单开门带线锚钉固定椎管扩大成形术治疗者37例(锚钉固定组),采用单开门微型钛板固定椎管扩大成形术治疗者33例(钛板固定组)。比较3组患者的手术时间、出血量、住院时间、JOA评分、最窄椎管面积、颈椎活动度、颈椎曲率指数及并发症发生情况。结果:1一般情况。3组患者手术时间、出血量及住院时间比较,组间差异均有统计学意义[(68.4±18.6)min,(79.8±21.3)min,(86.1±25.9)min,F=13.560,P=0.000;(346.3±85.7)m L,(364.1±83.2)m L,(436.2±89.4)m L,F=14.317,P=0.000;(53.3±4.8)d,(52.4±3.7)d,(32.4±4.5)d,F=19.492,P=0.000]。钛板固定组手术时间、出血量大于其余2组(P=0.000,P=0.000;P=0.000,P=0.000),住院时间比其余2组短(P=0.000,P=0.000);丝线固定组和锚钉固定组的手术时间、出血量及住院时间比较,组间差异均无统计学意义(P=0.326,P=0.824,P=0.536)。2JOA评分。手术前后不同时间JOA评分的差异有统计学意义,即存在时间效应[(7.5±3.6)分,(12.7±3.3)分,(13.2±3.7)分;(8.3±3.7)分,(12.8±3.8)分,(12.4±3.3)分;(7.6±2.5)分,(13.2±2.7)分,(14.5±2.6)分;F=56.672,P=0.000]。3组患者JOA评分的组间差异总体上有统计学意义,即存在分组效应(F=45.718,P=0.000);术前和术后1周时3组患者JOA评分比较,组间差异均无统计学意义(F=1.315,P=0.692;F=1.047,P=0.739);术后2年时,钛板固定组评分高于其余2组(P=0.002,P=0.000),其余2组间比较,差异无统计学意义(P=0.336)。时间因素和分组因素之间不存在交互效应(F=0.372,P=1.041)。3最窄椎管面积。手术前后不同时间最窄椎管面积的差异有统计学意义,即存在时间效应[(136.2±35.1)mm2,(274.3±42.5)mm2,(242.6±38.3)mm2;(135.7±32.6)mm2,(272.9±42.3)mm2,(258.7±35.4)mm2;(135.9±Objective：To observe the clinical curative effects and safety of three kinds of cervical unilateral open-door laminoplasty in posterior access.Methods：The medical records of 105 patients with multiple-segment cervical spinal cord compression were analyzed retro-spectively.The patients were treated with unilateral open-door laminoplasty and the open vertebral plates were fixed with suture silk（35 ）, suture anchor（37）and micro titanium plate（33）.The operative time,blood loss,hospital stay,JOA scores,minimal cross-sectional area of the vertebral canal,range of motion（ROM）of cervical vertebrae,cervical curvature index（CCI）and complications were compared between the 3 groups.Results：There was statistical difference in the operative time,blood loss and hospital stay between the 3 groups（68.4 ＋/-18.6,79.8＋/-21.3,86.1 ＋/-25.9 min,F=13.560,P=0.000;346.3＋/-85.7,364.1 ＋/-83.2,436.2＋/-89.4 mL,F=14.317,P=0.000;53.3＋/-4.8,52.4＋/-3.7,32.4＋/-4.5 d,F=19.492,P=0.000）.The operative time and blood loss of titanium plate group were greater than those of the other 2 groups（P=0.000,P=0.000;P=0.000,P=0.000）,while the hospital stay of titanium plate group was shorter than that of the other 2 groups（P=0.000,P=0.000）.There was no statistical difference in the operative time,blood loss and hospital stay between suture silk group and suture anchor group（P=0.326,P=0.824,P=0.536）.There was statistical difference in JOA scores between different time points,in other words,there was time effect（7.5 ＋/-3.6,12.7 ＋/-3.3,13.2 ＋/-3.7 points;8.3 ＋/-3.7, 12.8＋/-3.8,12.4＋/-3.3 points;7.6＋/-2.5,13.2＋/-2.7,14.5 ＋/-2.6 points;F=56.672,P=0.000）.In general,there was statis-tical difference in JOA scores between the three groups,in other words,there was group effect（F=45.718,P=0.000）.There was no sta-tistical difference in JOA scores between the three groups before treatment and one week after the treatment（F=1.315,P=0.692;F=1.047,P=0.739）.The JOA scores of the titanium p

关 键 词：颈椎 脊髓压迫症 椎间盘移位 后纵韧带骨化 椎管扩大成形术 

分 类 号：R687.3[医药卫生—骨科学]