保留与非保留单侧肌肉韧带颈椎后路单开门椎管扩大减压术联合微型钛板固定术治疗多节段脊髓型颈椎病疗效比较  

Comparative study on the effect of retention and non-retention of unilateral muscle ligament structure in posterior cervical unilateral open-door laminoplasty combined with miniature titanium plate fixation in the treatment of multisegmental cervical spond

作　　者：刘卫祥 LIU Wei-xiang(Department of Osteology,the People′s Hospital of Mianchi County,Mianchi 472400,Henan Province,China)

机构地区：[1]渑池县人民医院骨科,河南渑池472400

出　　处：《新乡医学院学报》2018年第8期727-730,共4页Journal of Xinxiang Medical University

摘　　要：目的比较保留与非保留单侧肌肉韧带颈椎后路单开门椎管扩大减压术联合微型钛板固定术治疗多节段脊髓型颈椎病(CSM)的临床效果。方法选择2013年1月至2016年5月于渑池县人民医院行颈椎后路单开门椎管扩大减压术联合微型钛板固定术的多节段CSM患者59例为研究对象,其中28例术中保留颈椎单侧肌肉韧带(保留组),31例术中不保留颈椎单侧肌肉韧带(非保留组)。记录2组患者的手术时间、术中出血量、切口长度、术中透视次数及住院时间;术后随访1 a,行颈椎正侧位X线片、CT或磁共振成像检查,测量椎板开门角度、脊髓后飘移距离及颈椎活动度(ROM)丢失角度;分别于术前及术后1 a采用日本骨科协会(JOA)评分评估颈椎功能,并计算JOA评分改善率;分别于术前及术后1 a采用视觉模拟评分法(VAS)评分评估患者疼痛程度,并计算VAS改善值;记录2组患者术后并发症发生情况。结果与非保留组比较,保留组患者手术时间长,术中出血量和术中透视次数多,住院时间短(P<0.05),但2组患者手术切口长度比较差异无统计学意义(P>0.05)。术后1 a,保留组患者椎板开门角度、ROM丢失角度小于非保留组,JOA评分改善率、VAS评分改善值大于非保留组(P<0.05),但2组患者脊髓后飘移距离比较差异无统计学意义(P>0.05)。保留组患者发生术后出血1例,脑脊液漏1例,第5颈神经麻痹1例,颈部轴性症状3例,并发症发生率为21.43%(6/28);非保留组患者发生术后出血1例,第5颈神经麻痹2例,颈部轴性症状6例,并发症发生率为29.03%(9/31);2组患者并发症发生率比较差异无统计学意义(χ2=0.449,P>0.05)。结论保留与非保留单侧肌肉韧带颈椎后路单开门椎管扩大减压术联合微型钛板固定术治疗多节段CSM均可获得较好的临床效果,而保留单侧肌肉韧带颈椎后路单开门椎管扩大减压术联合微型钛板固定术的治疗效果更佳。Objective To compared the effect of retention and non-retention of unilateral muscle ligament structure in posterior cervical unilateral open-door laminoplasty combined with miniature titanium plate fixation in the treatment of multisegmental cervical spondylotic myelopathy（CSM）.Methods A total of 59 patients with multisegmental CSM were selected from January 2013 to May 2016 in the People＇s Hospital of Mianchi County.All the patients were treated posterior cervical unilateral open-door laminoplasty combined with miniature titanium plate fixation,28 patients retained the unilateral muscle ligaments structure of the cervical spine during the operation（retention group）,31 patients did not retain the unilateral muscle ligaments structure of the cervical spine during the operation（non-retention group）.The operation time,intraoperative bleeding,incision length,intraoperative fluoroscopy times and hospitalization time of the patients in the two groups were recorded.The patients were followed up for one year after operation.The X-ray film,CT or magnetic resonance imaging of the cervical spine were performed to measure the laminar opening angle,the backward moving distance of the spinal cord and the loss angle of range of motion（ROM） of cervical spine.The cervical spine function was assessed by the Japanese Orthopaedic Association（JOA）score before operation and one year after operation,and the improvement rate of JOA score was calculated.The pain of the patients was evaluated by Visual analogue scale（VAS） before operation and one year after operation,and the VAS score improvement was calculated.Results Compared with the non-retention group,the operation time was longer,the intraoperative bleeding and the intraoperative fluoroscopy times were higher,and the hospitalization time was shorter in the retention group（P〈0.05）.There was no significant difference in incision length between the two groups（P〈0.05）.One year after operation,The laminar opening angle and the loss angle of ROM of c

关 键 词：多节段脊髓型颈椎病 椎管扩大术 微型钛板固定术 

分 类 号：R687.3[医药卫生—骨科学]