颈后路4种手术方式对颈椎曲度及轴性症状的研究  

Investigation of four different posterior operative ways on curvature index and axial symptom for multilevel cervical spondylotic myelopathy

作　　者：李鹏飞[1] 贾楠[1] 王立红[1] 靳宪辉[1] 李家承[1] 杨建博[1] 

机构地区：[1]哈励逊国际和平医院骨病科,河北衡水053000

出　　处：《河北医科大学学报》2017年第1期24-28,共5页Journal of Hebei Medical University

摘　　要：目的通过颈后路4种手术方式治疗多节段脊髓型颈椎病(multilevel cervical spondylotic myelopathy,MCSM),观察不同术式的选择对患者术后颈椎曲度指数(cervical curvature index,CCI)、椎间隙高度及轴性症状(axial symptom,AS)的临床意义。方法将MCSM患者134例随机分为4组:全椎板减压术(全椎板)组34例;颈后路单开门椎管成形术(单开门)组35例;颈后路侧块螺钉内固定术(侧块螺钉)组33例;颈后路椎弓根钉内固定术(椎弓根钉)组32例。均行颈椎正侧位X线、CT、MRI检查。对4组手术时间、出血量、术后引流量、康复时间、手术前后的神经功能、CCI、AS进行比较。结果 4组手术时间、出血量、术后引流量、康复时间差异均无统计学意义(P>0.05);4组日本骨科协会评分恢复率差异无统计学意义(P>0.05);单开门组、侧块螺钉组和椎弓根钉组CCI丢失率低于全锥板组,侧块螺钉组和椎弓根钉组CCI丢失率低于单开门组(P<0.05);侧块螺钉组和椎弓根钉组椎间隙高度丢失少于全锥板组和单开门组(P<0.05);4组颈椎AS评分分布和明显AS比例差异均无统计学意义(P>0.05)。结论颈后路椎板减压后应用内固定效果良好;虽然对患者术后康复率无明显影响,但可明显增加颈椎稳定性;能够有效防止术后曲度丢失,减少术后严重AS的发生。Objective To investigate the clinical significance of four different posterior operative ways on cervical curvature index（CCI） and axial symptom（AS） in the treatment of multilevel cervical spondylotic myelopathy （MCSM）. Methods One hundred and thirty-four patients with MCSM were randomly divided into four groups in this study. 34 patients underwent traditional laminectomy, 35 patients underwent open-door laminectomy, 33 patients underwent lateral mass screw fixation, 32 patients underwent cervical pedicle screw fixation. All the patients were examined with X-ray, CT and MRI. The operation time, bleeding volume, postoperative drainage volume, recovery time, nerve function before and after operation, CCI and AS were compared in 4 groups. Results There was no significant difference in operation time, bleeding volume, postoperative drainage volume and recovery time among 4 groups（P〉0.05） . There was no difference in Japanese Orthopaedic Association score recovery rate among 4 groups（P〉0.05）. The CCI loss rate of open-door laminectomy group, lateral mass screw group and pedicle screw group were less than that of traditional laminectomy group, the CCI screw group and pedicle screw group was less than that of open-door oss rate of lateral mass aminectomy group （P〈 0.05） . The intervertebral height of lateral mass screw group and pedicle screw group was lost less than that of traditional laminectomy group and open-door laminectomy group （P〈0.05）, There was no significant difference between the 4 groups in the axial symptoms and the distribution of AS（P〉0.05）. Conclusion Lateral mass screw and cervical pedicle screw fixation made a good clinical outcome. Although there was no significant effect on the postoperative recovery rate, the stability of cervical spine was significantly increased. They Can effectively prevent postoperative curvature loss and reduce the occurrence of serious AS.

关 键 词：颈椎病 椎板切除术 治疗结果 

分 类 号：R681.5[医药卫生—骨科学]