保留颈后肌韧带复合体的改良单开门椎板成形治疗脊髓型颈椎病:神经功能及轴性症状评价  

Modified open-door laminoplasty with preserved posterior cervical musculo-ligamentous complex in the treatment of cervical spondylotic myelopathy:neurological function and axial symptoms

作　　者：赵玲童 胡冰 Zhao Lingtong;Hu Bing(Department of Spine Orthopedics,Tianyou Hospital Affiliated to Wuhan University of Science&Technology,Wuhan 430064,Hubei Province,China)

机构地区：[1]武汉科技大学附属同济天佑医院脊柱骨科,湖北省武汉市430064

出　　处：《中国组织工程研究》2021年第33期5345-5350,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:脊髓型颈椎病通过直接或间接压迫脊髓或周围的血管而引起椎管狭窄、脊髓功能障碍,颈后路椎板成形治疗脊髓型颈椎病的疗效显著,在临床上应用广泛。目的:评价保留颈后肌韧带复合体的改良单开门椎板成形对脊髓型颈椎病的修复效果。方法:回顾性分析2015年6月至2018年7月武汉科技大学附属同济天佑医院收治的126例脊髓型颈椎病手术治疗患者的病历资料,根据手术方案分为2组,改良组72例患者行保留颈后肌韧带复合体的改良椎板成形治疗,对照组54例行传统椎板成形治疗。比较两组患者的基线资料、手术时间、术中失血量、颈椎曲度指数、运动范围、颈后肌体积,在术前和术后24个月末次随访时记录日本骨科协会评分、目测类比评分及颈部功能障碍指数,术后记录并发症发生率。结果与结论:①末次随访发现改良组患者颈椎屈曲度、运动范围、颈椎曲度指数均优于对照组患者(P<0.01);②与对照组相比,改良组患者末次随访目测类比评分和颈部功能障碍指数明显降低(P<0.01);③改良组患者末次随访铰链侧肌颈后椎旁肌体积与术前比较差异无显著性意义,但与对照组相比明显增大,差异有显著性意义(P<0.01);④此外,改良组患者轴性症状的发生率明显低于对照组(6%vs.22%),差异有显著性意义(P<0.05);⑤提示保留颈后肌韧带复合体的改良单开门椎板成形是治疗脊髓型颈椎病的有效方法,可显著恢复患者神经功能,颈椎曲度和运动范围保持良好;此外与传统的开门椎板成形相比,可减少术后轴性症状的发生率。BACKGROUND:Cervical spondylotic myelopathy causes spinal canal stenosis and spinal cord dysfunction through direct or indirect compression of the spinal cord or surrounding blood vessels.Posterior cervical laminoplasty for cervical spondylotic myelopathy is effective and widely used in clinical practice.OBJECTIVE:To evaluate the repair effect of modified open-door laminoplasty with preserved posterior cervical musculo-ligamentous complex in the treatment of cervical spondylotic myelopathy.METHODS:Medical record data of 126 patients with cervical spondylotic myelopathy from Tianyou Hospital Affiliated to Wuhan University of Science&Technology from June 2015 to July 2018 were retrospectively analyzed.They were assigned to two groups according to the surgical program.The 72 patients in the modified group received modified open-door laminoplasty with preserved posterior cervical musculo-ligamentous complex.The 54 patients in the control group received traditional vertebral plate keratoplasty.Baseline data,operation time,intraoperative blood loss,cervical curvature index,range of motion,and posterior cervical volume were compared between the two groups.Japanese Orthopaedic Association Scores,visual analogue scale scores,and Neck disability index were recorded before surgery,24 months after surgery,and during final follow-up.The incidence of complications was recorded after surgery.RESULTS AND CONCLUSION:(1)The last follow-up showed that the cervical curvature rate,range of motion,and cervical curvature index in the modified group were better than those in the control group(P<0.01).(2)Compared with the control group,visual analogue scale score and Neck disability index were significantly lower in the modified group(P<0.01).(3)The body volume on the hinge side in the modified group was not significantly different from that before surgery,but it was significantly increased compared with the control group(P<0.01).(4)In addition,the incidence of axial symptoms in the modified group was significantly lower than that in the

关 键 词：脊髓型颈椎病 开门椎板成形 轴性症状 颈后肌韧带复合体 颈椎曲度 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]