颈椎椎管成形术后轴性症状相关研究进展  

Axial symptoms after cervical laminoplasty

作　　者：蒋继乐[1] 田伟[1] 

机构地区：[1]北京积水潭医院脊柱外科,100035

出　　处：《中华骨科杂志》2017年第9期569-576,共8页Chinese Journal of Orthopaedics

基　　金：“使命”人才培养计划（SML20150401）;国家自然基金重大项目（81330043）

摘　　要：轴性症状又称轴性疼痛或轴性颈痛，是颈椎后路手术常见并发症，不仅包括颈背部疼痛，而且还包括颈背部僵硬、紧张、肌肉酸胀等不适感，其发病率为5．2％～61．5％，难以自愈，严重降低了患者术后生活质量，并影响了颈椎椎管成形术的治疗效果。轴性症状起病时间分为术后早期和术后晚期，两者发生机制和原因各不相同，常难以自行消退。一般C2～C7椎管成形术后轴性症状的发病率较高，而各种保留后方肌肉一韧带复合体的改良手术可明显降低轴性症状的发生。其中C2棘突作为颈半棘肌止点，能减少术后后凸畸形的发生，C7棘突作为后方肌肉一韧带复合体的重要组成结构，在不影响减压范围的前提下，均应尽量保留，从而保持肌肉起止点结构完整，确保患者能通过康复锻炼恢复至术前的状态。而坚强内固定是另一类改良手术的方向，也能避免再关门发生，减少软组织损伤，但需注意的是，避免内固定损伤关节突引起轴性症状。轴性症状的危险因素除了颈肩部疼痛、僵硬外，其他均不明确，术后活动度丢失以及颈椎曲度变化与轴性症状发生之间并没有一定的联系，其可能是颈后方肌肉软组织萎缩带来的不同后果。虽然目前尚没有椎管成形手术方式的金标准，但脊柱外科医生应遵循以下原则：尽可能保留C2和C7棘突，并在此基础上选择坚强固定，避免再关门的发生，同时减少术后佩戴颈托时间，早期行功能锻炼，从而最大程度减少轴性症状的发生。Axial symptom, also called axial pain or axial neck pain, is a common complication after posterior cervical spine surgery. The symptom can be neck pain, as well as rigid, tension and dullness. The incidence of axial syndrome is estimated between 5.2% and 61.5%. Often, the symptom does not disappear spontaneously. The quality of patients＇ life as well as the effec- tiveness of cervical laminoplasty is affeeted. It can be divided into early and late axial pain based on the onset time. The mecha- nism and reason are different, but both are difficult to subside. The incident of axial symptom is relatively high in conventional laminoplasty. However the modified one which preserve posterior ligament-muscular structure can reduce the incidence signifi- cantly. C2 spinal process as the attachment of cervical semispinalis, could reduce the incidence of kyphosis after operation. And C7 spinal process is an important structure in posterior ligament-muscular structure. Both should be preserved as much as possible in order to maintain intact attachment of muscles, which facilitates the patient to restore soft tissue tension by rehabilitation. Rigid fix- ation is another method of modification, it could avoid re-close of the open door, and reduce soft tissue injury. However, attention must be paid not to destroy facet joint to cause new axial symptom. Risk factors of axial symptom include past shoulder and neck pain and stiffness, others remain controversial. There is no correlation between loss of range of motion after surgery as well as change of cervical alignment and axial symptom. It is more likely to be a different result due to muscle atrophy. Although there are no golden standard of laminoplasty, doctors should follow these principles： preserve C： and C7 spinal process when possible, rigid fixation to avoid reclose, reduce immobilization after operation, and encourage patient to start rehabilitation as early as possible to reduce incident of axial symotom.

关 键 词：术后生活质量 颈椎后路手术 椎管成形术 轴性症状 肌肉起止点 坚强内固定 韧带复合体 软组织损伤 

分 类 号：R687.3[医药卫生—骨科学]