颈椎后路3种手术方式对多节段脊髓型颈椎病生理曲度的影响及远期疗效观察  

Influence of three cervical posterior surgical methods on physiological curvature of multi-segmental cervical spondylosis myelopathy and their long-term effects

作　　者：苟波[1] 苏权[2] GOU Bo;SU Quan(Baoji City Traditional Chinese Medicine Hospital, Baoji Shanxi 721001, China)

机构地区：[1]宝鸡市中医医院骨科,陕西宝鸡721001 [2]宝鸡市人民医院脊柱创伤科,陕西宝鸡721001

出　　处：《空军医学杂志》2018年第1期28-31,35,共5页Medical Journal of Air Force

基　　金：国家自然科学基金项目(81501929)

摘　　要：目的观察颈椎后路3种手术方式对多节段脊髓型颈椎病生理曲度的影响及其远期疗效。方法选取2012年1月—2014年6月在宝鸡市中医医院住院治疗的多节段脊髓型颈椎病患者126例,根据手术方式的不同分为颈椎后路单开门椎管扩大成形术组(A组)44例、颈椎后路全椎板切除术组(B组)39例和颈椎后路全椎板减压侧块螺钉内固定术组(C组)43例。术后所有患者均完成12个月的随访,观察患者术前、术后3、12个月的神经功能恢复情况和轴性症状,并测量颈曲夹角和椎间高度。结果 3组患者术后3、12个月采用日本矫形外科协会(JOA)评分、视觉模拟评分(VAS)均较术前明显升高(P<0.05),且术后12个月,A组和C组患者JOA评分均高于B组,VAS评分均低于B组(P<0.05),而A组和C组之间差异无统计学意义(P>0.05)。术后12个月,A组和C组神经功能改善的优良率明显高于B组(P<0.05)。术后3个月3组颈曲夹角与术前比较差异有统计学意义(P<0.05)。术后12个月,C组颈曲夹角与A组、B组相比,差异有统计学意义(P<0.05)。结论颈椎后路3种手术方式治疗多节段脊髓型颈椎病均有较好的近期疗效。从远期疗效来看,颈椎后路单开门椎管扩大成形术和颈椎后路全椎板减压侧块螺钉内固定术对术后神经功能和轴性症状的改善要明显优于颈椎后路全椎板切除术;而颈椎后路全椎板减压侧块螺钉内固定术相较于其他两种术式能够更有效地恢复颈椎曲度和椎间高度,不失为颈椎后路减压、固定的一种可靠的术式。Objective To observe the inf luence of three cervical posterior surgical methods on the physiological curvature of multi-segmental cervical spondylosis myelopathy and their long-term effects.Methods One hundred and twenty-six cases of patients with multi-segmental cervical spondylosis myelopathy treated in our hospital between January2012and June2016were selected as subjects,who were divided into the expansive open-door laminoplastyby cervical posterior approach group(Group A)44people,laminectomyby cervical posterior approach group(Group B)39people and laminectomy and lateral mass screw fixationby cervical posterior approach group(Group C)43people according to different surgical methods.All the patients were followed up for12months.The recovery of neurological function and axial symptoms before operation and3,12months after operation were observed,while the cervical f lexure angle and intervertebral height before operation and3,12months after operation were detected.Results The scores of Japanese orthopedic association(JOA)and visual analogue scale(VAS)in the three groups3and12months after operation were higher than those before operation(P<0.05).12months after operation,the scores of JOA in Group A and Group C were higher than those in Group B,the scores of VAS in Group A and Group C were lower than those of Group B(P<0.05),but there was no significant difference between Group A and Group C(P>0.05).12months after operation,the excellence rate of neurological function in Group A and Group C was higher than that of Group B(P<0.05).3months after operation,the cervical flexure angle in the three groups was significantly different(P<0.05).12months after operation,Group C was significantly different from Group A and Group B(P<0.05).Conclusions The three cervical posterior surgical methods for multi-segmental cervical spondylosis myelopathy have better short-term effects.However,in terms of long-term effects,the improvement of expansive open-door laminoplasty by cervical posterior approach and laminectomy and lateral m

关 键 词：多节段脊髓型颈椎病 生理曲度 远期疗效 颈椎后路单开门椎管扩大成形术 颈椎后路全椎板切除术 颈椎后路全椎板切除侧块螺钉内固定术 

分 类 号：R653[医药卫生—外科学]