颈椎后路不同术式治疗发育性颈椎管狭窄并颈椎间盘突出症疗效比较  

A comparative study on the outcome of different posterior surgical procedure for patients with developmental cervical stenosis and cervical disc herniation

作　　者：李威霖[1] 吴涛[1] 李沫[2] 谢宁[3] 王刚[1] 刘军[1] 

机构地区：[1]南京医科大学第二附属医院骨科,江苏南京210011 [2]第四军医大学西京医院骨科,陕西西安710032 [3]第二军医大学附属长征医院骨科,上海200003

出　　处：《南京医科大学学报（自然科学版）》2015年第2期201-206,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(81271987;81301036);陕西省自然科学基础研究计划(2013JQ4025)

摘　　要：目的 :比较两种颈椎后路不同术式治疗发育性椎管狭窄并颈椎间盘突出症临床疗效,为临床两种术式选择提供理论支持。方法:本文回顾了73例采用颈椎后路两种不同术式(单开门椎管扩大成形内固定术或全椎板切除减压内固定术)治疗发育性颈椎管狭窄并颈椎间盘突出症患者临床资料,其中单开门椎管扩大成形术35例,全椎板切除减压内固定术38例。统计两组患者年龄、性别、手术时间、术中出血量、病情程度、C5神经根麻痹症、JOA评分、VAS评分,比较两种术式差异。结果:本研究中患者术后症状及体征较术前均有明显改善,两组患者在手术时间、出血量、术后1周JOA评分及其改善率、C5神经根麻痹症状发生率指标上存在显著性差异(P<0.05),其余指标两组间未见显著性差异(P>0.05)。结论:虽然颈椎后路全椎板减压术可以早期较好地减轻发育性颈椎管狭窄并颈椎间盘突出症患者神经症状,两种术式末次随访疗效相近,但是颈椎后路单开门椎管成形术具有手术时间短、术中出血少、C5神经根麻痹症状发生率低等优势。Objective：A curative effect comparison on treatment of developmental cervical spinal Stenosis and cervical disc herniation by different procedures of posterior cervical Spine,which can provide theoretical support for two clinical operational choices. Methods：This paper reviewed 73 cases clinical data,whlch adopted two different posterior cervical spine procedures （single- door decompression laminoplasty or laminectomy lateral mass fixation）to treat patients with developmental cervical stenosis and cervical disc herniation,including 35 cases for single-door decompression laminoplasty and 38 cases for laminectomy lateral mass fixation. It also recorded the two group information like age, gender, surgical time, blood loss, morbid state,incidence of C5 nerve root palsy,JOA score,VAS score to compare the difference of two surgical procedures. Results：Compared with pre-operation,the postoperative symptoms and signs of both groups in this study improved obviously（P 〈 0.05）. The significant difference was found in indicators of surgical time,blood loss,JOA scores after one-week surgery and its improvement rate,incidence of C5 nerve root palsy symptoms（P 〈 0.05）,with the rest of indicators between two groups were not observed. Conclusion：Laminectomy lateral mass fixation can early ease patients＇ neurologic symptoms who suffered from developmental cervical spinal stenosis and cervical disc herniation, and two kinds of operations were similar in last follow-up curative effect. However,single-door decompression laminoplasty owns advantages like shorter operation time,less intraoperative bleeding,incidence of C5 nerve root palsy symptoms.

关 键 词：发育性颈椎管狭窄 颈椎间盘突出 椎板切除减压术 单开门椎管成形术 

分 类 号：R681.53[医药卫生—骨科学]