单开门椎管扩大成形术中保留棘突及颈后韧带复合体的意义及疗效分析  

Significance and effects of reserving spinous process and posterior ligamentous complex in the procedure of laminoplasty

作　　者：李东风[1] 刘法敬[1] 胡成栋[1] 霍喜卫[1] 王瑞[1] 李彦飞[1] 

机构地区：[1]河北省邯郸市中心医院骨2科,河北邯郸056001

出　　处：《河北医科大学学报》2017年第5期535-538,F0003,共5页Journal of Hebei Medical University

基　　金：河北省医学科学研究重点课题(20150452);河北省科技计划项目(12277750)

摘　　要：目的观察单开门微型钛板固定椎管成形术中保留棘突及重建颈后方韧带复合体的临床意义及手术疗效。方法将89例颈椎管狭窄症患者根据手术方式分为常规单开门微型钛板固定组(A组)47例和保留韧带复合体单开门组(B组)42例,比较2组术前和末次随访时日本骨科协会(Japanese Orthopaedic Association,JOA)评分、疼痛视觉模拟评分法(Visual Analogue Scale,VAS)评分、颈椎曲度指数和颈后肌群横截面积的变化以及随访情况。结果 2组患者均顺利完成手术,未出现脊髓及神经损伤情况。末次随访时2组JOA评分、VAS评分较术前明显升高,颈椎曲度指数、颈后肌群截面积较术前明显减少,差异均有统计学意义(P<0.05);末次随访时2组JOA评分差异无统计学意义(P>0.05),B组VAS评分明显低于A组,且B组的颈椎曲度指数和颈后肌群横截面积大于A组,差异均有统计学意义(P<0.05)。2组手术时间和术中出血量差异均无统计学意义(P>0.05)。结论单开门微型钛板固定术可以有效促进颈椎管狭窄症患者神经功能的恢复,术中保留棘突及重建颈后方韧带复合体可更好的维持颈椎曲度,减轻颈后肌群的萎缩,降低术后轴性症状的发生。Objective To investigate the significance and clinical effects of reserving spinous process and rebuild posterior ligamentous complex in the procedure of laminoplasty with mini titanium plate fixation.Methods Eighty-nine cases of cervical stenosis patients were divided into2 groups based on the operation procedure they accepted.Forty-seven patients in group A,who reserving spinous process and rebuild posterior ligamentous complex.Forty-two patients in group B,who accepted normal laminoplasty.The Japanese Orthopaedic Association（JOA）score,Visual Analogue Scale（VAS）score,cervical curvature index,posterior cervical muscle crosssectional area were recorded and analyzed at the point of preoperative and final follow-up.Results No spinal cord and nerves injury occurred during the operation.At the point of final follow-up,both of the 2groups had a significant increase in JOA score and VAS score（P〈0.05）,and had a significant decrease in cervical curvature index and posterior cervical muscle cross-sectional area（P〈0.05）.There was no significant difference in JOA score between the 2 groups（P〉0.05）.However,at the final follow-up,group B had a lower VAS score and a better cervical curvature index,posterior cervical muscle cross-sectional area maintained than group A（P〈0.05）.Both of the 2groups had no significant difference at operative time and blood loss（P〈0.05）.Conclusion Laminoplasty with mini titanium plate fixation could improve the neurological function effectively for cervical stenosis patients.Moreover,if reserving spinous process and rebuild posterior ligamentous complex,a weaker axial symptom,a better cervical curvature index and a slight neck muscle atrophy will be achieved.

关 键 词：椎管狭窄 椎管成形术 颈后肌萎缩 

分 类 号：R681.5[医药卫生—骨科学]