椎管扩大成形术治疗伴生理前凸消失多节段颈椎疾病的疗效分析  

Posterior enlargement of spinal canal for the treatment of multi-segmental cervical diseases without cervical lordosis

作　　者：钱宇[1] 金聪[1] 何磊 洪正华[2] 赵晓峰[1] 谢明华[1] 朱国庆[1] 

机构地区：[1]绍兴市人民医院(浙江大学绍兴医院)骨科,312000 [2]浙江省台州医院骨科,317000

出　　处：《中华骨科杂志》2017年第24期1521-1529,共9页Chinese Journal of Orthopaedics

基　　金：浙江省卫生高层次创新人才培养工程项目（CXRC20140160000118）;浙江省公益性计划项目（2014C33150）;浙江省自然科学基金项目（LY15H060005）

摘　　要：目的 评估后路椎管扩大成形术治疗伴生理前凸消失多节段颈椎疾病的可行性及其临床疗效。方法 回顾性分析2013年1月至2017年6月，采用后路椎管扩大成形术治疗伴生理前凸消失的多节段颈椎疾病患者21例，并获得完整随访。男14例，女7例；年龄42~65岁，平均（53.9±7.3）岁。脊髓型颈椎病14例、颈椎后纵韧带骨化症5例和先天性颈椎骨性椎管狭窄症2例。测量并比较手术前后颈椎前凸角度和颈椎曲率指数；在颈椎MRI上测量术前及术后1年的椎管、脊髓前后径及其面积，评估术后椎管扩大及脊髓膨大程度；采用日本骨科协会（Japanese Orthopaedic Association Scores，JOA）评分评估神经功能改善情况,采用疼痛视觉模拟评分（visual analogue scale，VAS）评估疼痛改善情况，采用Frankel分级评估脊髓损伤严重程度恢复情况。结果 随访时间12~26个月，平均16.4个月。颈椎前凸角术前和术后1年分别为3.1°±2.3°和4.2°±1.6°，两者差异有统计学意义。颈椎曲率指数术前和术后1年分别为4.4%±1.7%和5.0%±1.5%，两者差异无统计学意义。除C7T1水平外，在C2，3、C3，4、C4，5、C5，6、C6，7椎间隙水平术后1年椎管前后径及椎管面积均较术前增大，差异有统计学意义。除C2，3及C7T1水平外，在C3，4、C4，5、C5，6、C6，7椎间隙水平术后1年脊髓前后径及脊髓面积均较术前增大，差异有统计学意义。术前JOA评分为（8.9±1.7）分，术后3个月为（13.1±2.0）分，与术前比较差异有统计学意义，平均改善率为52.0%，优良率为52.3%；术后1年JOA评分为（13.3±2.1）分，与术前比较差异有统计学意义，平均改善率为54.3%，优良率为61.9%。术前VAS评分为（3.0±2.4）分，术后1年为（2.7±1.7）分，手术前后比较差异无统计学意义。术前Frankel分级C级1例（4.8%）、D级8例（38.1%）、E级12例（57.1%）；术后1年时C级1例无变化Objective To evaluate the feasibility and efficacy of posterior enlargement of spinal canal for the treatment of multi-segmental cervical diseases without cervical lordosis.Methods From January 2013 to June 2017, a retrospective study was conducted with 21 patients of multi-segmental cervical diseases accompanied cervical lordosis loss, and the complete follow-up data was obtained. There were 14 males and 7 females, with an average age of 53.9±7.3 years （range, 42-65 years）. There were 14 multi-segmental cervical spondylotic myelopathy, 5 ossification of posterior longitudinal ligament, and 2 congenital cervical stenosis included in this study. The cervical lordotic angle and cervical curvature index were measured preoperatively and 1 year postoperatively. To access the enlargement of spinal canal and spinal cord, the anteroposterior diameter and cross section area of spinal canal or spinal cord were measured on MRI preoperatively and 1 year postoperatively. The Japanese Orthopaedic Association Scores （JOA） was applied to evaluate the neurological function at preoperation and postoperation. Visual Analogue Scales （VAS） was applied to evaluate the pain degree at preoperation and postoperation. Frankel classification was used to assess the severity of spinal cord injury at preoperation and postoperation.Results The follow-up time was 12-26 months, with an average of 16.4 months. The cervical lordosis angle was 3.1°±2.3° preoperatively, and 4.2°±1.6° 1 year postoperatively with a significant difference. The cervical curvature index was 4.4%±1.7% preoperatively and 5.0%±1.5% 1 year postoperatively with no statistically difference. Except for C7T1 level, the preoperative anteroposterior diameter and cross section area of spinal canal at C2,3, C3,4, C4,5, C5,6, and C6,7 level were lower than that at 1 year after operation with a significant difference. Except for C2,3 and C7T1 and level, the preoperative anteroposterior diameter and cross section area of spinal cord at C3,4, C4,5, C5,6, and C6,7 le

关 键 词：颈椎 椎管狭窄 脊髓压迫症 

分 类 号：R687.3[医药卫生—骨科学]