保留双侧半棘肌的颈椎单开门椎管扩大成形术治疗多节段颈椎疾患  

The efficacy of unilateral open-door laminoplasty with reserved bilateral semispinalis in treating multi-level cervical diseases

作　　者：曹锐[1] 梁卫东[1] 安忠诚 王健[1] 郭海龙[1] 买尔旦·买买提[1] 甫拉提·买买提[1] 盛军[1] 盛伟斌[1] Cao Rui Liang Weidong An Zhongcheng Wang Jian Guo Hailong Mardan · Mamat Pulati · Mamat Sheng Jun Sheng Weibin(Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China Department of Spinal Surgery, the Second Affiliated Hospital of Zhefiang Chinese Medical University, Hangzhou 310005, China)

机构地区：[1]新疆医科大学第一附属医院脊柱外科,乌鲁木齐830054 [2]浙江中医药大学附属第二医院脊柱外科,杭州310005

出　　处：《中华骨科杂志》2017年第3期153-161,共9页Chinese Journal of Orthopaedics

摘　　要：目的评价经肌间隙保留双侧半棘肌的单开门椎管扩大成形术治疗多节段颈椎疾患的疗效。方法2013年1月至2015年12月采用自行改良设计的经肌问隙保留双侧半棘肌的单开门椎管扩大成形术治疗多节段慢性压迫性颈椎疾患33例，男19例，女14例；年龄35-75岁，平均（57．22±10．75）岁。手术节段为C3-C6。同一时间段内采用C3-C6保留棘上韧带的单开门椎管扩大成形术治疗的同类患者32例、C3～C7传统单开门椎管扩大成形术治疗的同类患者35例。比较三组患者的年龄、性别、疾病诊断、手术时间、术中出血量、术前和末次随访时的颈椎曲度、活动度、轴性症状、疼痛视觉模拟评分（visual analogue scale，VAS）、日本骨科协会（Japancse Orthopaedic Association，JOA）颈椎评分、颈部功能障碍评分（the neck disability index，NDI）和并发症情况。结果三组患者性别、年龄、随访时间、疾病类型、术前颈椎活动度和颈椎曲度、手术时间和出血量的差异均无统计学意义。末次随访时，传统手术组颈椎活动度和颈椎曲度分别为34．380±7．960和11．89°±7．70°，较术前明显丢失（P〈0．05）；保留半棘肌组分别为38．41°±7．33°和14．60°±8．56°，保留棘上韧带组分别为37．63°±4．91°和14．34°±8．02°，与术前比较均无明显丢失，且大于传统手术组（P〈0．05）。末次随访时，三组JOA评分和NDI评分均较术前改善，保留半棘肌组和保留棘上韧带组疼痛VAS评分较术前改善；三组间JOA评分及其改善率的差异无统计学意义，而VAS和NDI评分的差异有统计学意义，保留半棘肌组的疼痛VAS和NDI评分更小。患者术后早期均有颈部疼痛症状，随访期间19例（19％）出现轴性症状，其中保留半棘肌组2例（6％）、保留棘上韧带组5例（16％）、传统手术组12例（34％），发生率的差异有统计学意义。术后出现C5Objective To evaluate the efficacy of unilateral open-door laminoplasty with reserved bilateral semispinalis for the treatment of multi-level cervical diseases. Methods A retrospective study of prospectively collected data from hospital was conducted. From January 2013 to December 2015, thirty-three patients with multi-level cervical disease underwent C3-C6 unilateral open-door laminoplasty with reserved bilateral semispinalis. There were 19 males and 14 females with average age 57.22±10.75 years （range 35-75 years）. Moreover, 32 patients with multi-level cervical disease underwent unilateral open-door laminoplasty with only reserved supraspinal ligamentum, and 35 underwent C3-C7 traditional open-door laminoplasty at the same time. The demographics, operation duration, blood loss volume, cervical curvature, range of motion, axial symptoms, visual analogue scale （VAS）, Japanese Orthopaedic Association （JOA） score, the neck disability index （NDI） and complications were recorded and analyzed at preoperation, postoperation and at final follow-up. Results The demographics, cervical curvature and range of motion at preoperation, operation duration and blood loss were not significantly difference among three groups （P〉0.05）. Cervical curvature and range of motion of traditional open-door laminoplasty were 34.38°±7.96° and 11.89°±7.70° at final follow-up （P〈0.05）. Cervical curvature and range of motion of unilateral open-door laminoplasty with reserved bilateral semispinalis were 38.41°± 7.33° and 14.60°±8.56°, and unilateral open-door laminoplasty with only reserved supraspinal ligamentum were 37.63°±4.91°and 14.34°±8.02°. There were significant differences among these 3 groups （P〈0.05）. JOA and NDI score of three groups were significantly improved at final follow-up （P〈0.05）. VAS of reserved bilateral semispinalis and reserved supraspinal ligamentum of unilateral open-door laminoplasty were significantly improved at final follow-up （P〈0.05）. JOA and recov

关 键 词：颈椎病 后纵韧带骨化 椎管狭窄 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]