C3-7与C4-7节段颈椎单开门椎板成形术治疗脊髓型颈椎病的疗效比较  

COMPARISON OF THE CURATIVE EFFECTS OF C3-7 AND C4-7 CERVICAL SINGLE DOOR LAMINOPLASTY IN THE TREATMENT OF CERVICAL SPONDYLOTIC MYELOPATHY

作　　者：张兴旭 王又君 冯超[1] 张书熠 张义龙[2] ZHANG Xing-xu;WANG You-jun;FENG Chao(Chengde Medical College,Hebei Chengde 067000,China)

机构地区：[1]承德医学院,河北承德067000 [2]承德医学院附属医院脊柱外一科

出　　处：《承德医学院学报》2020年第2期105-109,共5页Journal of Chengde Medical University

摘　　要：目的:评价保留C2椎体后方颈半棘肌止点的颈椎单开门椎板成形术治疗脊髓型颈椎病的临床疗效。方法:60例脊髓型颈椎病患者根据手术方式不同,分为A组和B组,各30例。A组患者实施C3-7颈椎单开门椎板成形术,B组实施C4-7颈椎单开门椎板成形术。统计分析患者术前与末次随访时日本骨科协会(JOA)评分,并计算神经功能改善率;比较两组患者术前与末次随访时颈椎曲度(Cobb角),以及记录患者术后轴性症状、C5神经根麻痹等并发症发生情况。结果:两组患者末次随访时颈椎曲度均较术前丢失,术前、术后比较差异有统计学意义(P<0.05);末次随访时A组患者的Cobb角明显低于B组(P<0.05)。两组患者术前、术后JOA评分,以及神经功能改善率、并发症发生率比较,差异均无统计学意义(P>0.05)。两组术后JOA评分均明显高于术前(P<0.05)。结论:C3-7与C4-7节段颈椎单开门椎板成形术治疗脊髓型颈椎病均能获得显著的神经功能恢复效果,而保留C2棘突颈半棘肌止点的颈椎单开门椎板成形术,不仅有助于维持颈椎曲度,并且能降低轴性症状发生率。Objective:To evaluate the effects of cervical single-door laminoplasty that preserving insertion of semi-spinus muscle on C2 vertebral body for treating cervical spondylotic melopathy.Methods:60 patients with cervical spondylotic myelopathy were divided into group A and group B according to different surgical methods,30 patients in each group.The patients in group A received C3-7 cervical single-door laminoplasty,the patients in group B received C4-7 cervical single-door laminoplasty.The JOA scores of patients before and at the last follow-up were analyzed,and the improvement rate of neurological function was calculated;The cervical curvature(Cobb angle)of the two groups before and at the last follow-up were compared;And the incidence rate of postoperative axial symptoms,C5 nerve root paralysis were recorded.Results:At the last follow-up,the cervical curvature of patients in 2 groups was obviously lost compared with that before operation(P<0.05);At the last follow-up,the Cobb angle of patients in group A was obviously lower than group B(P<0.05).There was no significant difference in JOA score before and after operation,neurological improvement rate and incidence rate of complications between group A and group B(P>0.05).The JOA score of patients in 2 groups after operation were all obviously higher than than before operation(P>0.05).Concusions:Treating cervical spondylotic myelopathy with C3-7 and C4-7 cervical single door laminoplasty all can get significant recovery of neurological function.While the cervical single-door laminoplasty with preservation of hemi-spinus muscles insertion on C2 vertebral body not only can maintain the cervical curvature,but also can decrease the incidence rate of axial symptoms.

关 键 词：脊髓型颈椎病 椎板成形术 轴性症状 颈椎曲度 

分 类 号：R681.5[医药卫生—骨科学]