责任节段颈后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病  

Responsible segment unilateral posterior cervical expansive open-door laminoplasty for multi-level cervical spondylotic myelopathy

作　　者：郭雄飞[1] 徐峰[2] 李涛[2] 熊承杰[2] GUO Xiong-fei;XU Feng;LI Tao;XIONG Cheng-jie(Orthopedic Department,Nanyang Municipal Center Hospital,Nanyang 473009,China;Orthopedic Department,Wuhan General Hospital,PLA,Wuhan 430070,China)

机构地区：[1]南阳市中心医院骨科,河南473009 [2]中国人民解放军武汉总医院骨科,武汉430000

出　　处：《中国临床神经外科杂志》2018年第8期519-522,共4页Chinese Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(81401802)

摘　　要：目的对比广泛式与责任节段颈后路单开门椎管扩大成形术(EOLP)治疗多节段脊髓型颈椎病(MCSM)的临床效果。方法回顾性分析自2013年3月至2015年5月接受EOLP治疗的41例MCSM的临床资料。采用广泛式EOLP治疗24例(广泛式组),采用责任节段EOLP治疗17例(责任节段组)。结果广泛式组术后随访(17.63±4.12)个月,责任节段组术后随访(18.15±3.92)个月。责任节段组手术时间、术中出血量、术后引流量、术后住院时间均明显减少(P<0.05)。术后12个月,广泛式组日本骨科协会(JOA)评分[(14.78±1.25)分]与责任节段组[(14.57±1.31)分]无统计学差异(P>0.05);末次随访,广泛式组JOA评分[(15.01±1.34)分]与责任节段组组[(14.76±1.28)分]无统计学差异(P>0.05)。末次随访,责任节段组明显轴性症状比例(17.65%,3/17)明显低于广泛式组(50.00%,12/24;P<0.05)。结论广泛式与责任节段EOLP治疗MCSM疗效均肯定,但后者具有损伤小、恢复快、可明显降低术后颈椎轴性症状等优势。Objective To compare the clinical effects of extensive posterior cervical expansive open-door laminoplasty(EOLP)on multiple segments cervical spondylotic myelopathy(MCSM)with those of responsible segment unilateral posterior cervical EOLP.Methods Of 41 patients with MCSM undergoing microsurgery from March,2013 to May,2015,24(group A)were treated by extensive EOLP and 17(group B)by responsible segment EOLP.The operative duration,intraoperative blood loss volume,postoperative drainage fluid volume,postoperative hospital stay and axial symptoms(AS)were compared between both the groups.Neurological function was determined before and after the surgery by Japanese Orthopaedic Association score(JOA)in both the groups.All the patients were followed up from 16 to 40 months.Results The operation duration,volume of intraoperative blood loss,volume of postoperative drainage fluid and postoperative hospital stay were significantly fewer in group B than those in group A(P<0.05).The percentage of patients with obvious cervical spine AS was significantly lower in the B group than that in the A group(P<0.05).There was no significant difference in the JOA scores between the two groups before and after the operation(P>0.05).Conclusion The effects of extensive and responsible segment posterior cervical EOLP on MCSM are all good.However,the latter has the advantages including little operative side injury,rapid recovery,and less postoperative cervical spine AS and is worthy of clinical spread.

关 键 词：多节段脊髓型颈椎病 椎管扩大成形术 颈后路 单开门 广泛式 责任节段 疗效 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]