改良后路双开门颈椎椎管成形术后十年以上的随访研究  

Long-term clinical study of modified posterior double-door cervical laminoplasty,more than ten years follow-up

作　　者：蒋继乐[1] 李祖昌 安岩[1] 葛腾辉 何达[1] 茅剑平[1] 刘波[1] 田伟[1] Jiang Jile;Li Zuchang;An Yan;Ge Tenghui;He Da;Mao Jianping;Liu Bo;Tian Wei(Department of Spinal Surgery,Beijing Jishuitan Hospital,The Fourth Clinical Medical College of Peking University,Beijing 100035,China)

机构地区：[1]北京积水潭医院脊柱外科,北京大学第四临床医学院,100035

出　　处：《中华骨科杂志》2021年第10期611-617,共7页Chinese Journal of Orthopaedics

基　　金：首都卫生发展科研专项(2020-4-2076);积水潭学科骨干(XKGG20814)。

摘　　要：目的:探讨改良棘突纵割双开门椎管扩大成形术(spinous process splitting laminoplasty using coralline hydroxyapatite,SLAC)的长期临床疗效及其并发症。方法:回顾性纳入2005年5月至2011年7月行SLAC手术治疗的患者,收集围手术期资料,并进行随访研究,共纳入病例165例。男115例,女50例;年龄(56.5±11.4)岁(范围26~84岁),随访时间(136.5±23.2)个月(范围108~182个月)。采用改良日本骨科协会(modified Japanese Orthopedic Association,mJOA)评分、颈椎功能障碍指数(neck disability index,NDI)评价患者临床疗效,影像学评估指标为患者的颈椎曲度和颈椎活动度变化,并记录患者并发症的发生情况。结果:mJOA评分由术前的(11.4±2.9)分改善至术后早期(15.0±1.8)分,mJOA改善率为63.5%;但在末次随访时下降到(14.0±2.5)分(F=77.096,P<0.001),mJOA改善率降至50.8%。NDI由术前19.2%±14.4%,下降到术后早期的13.0%±15.0%,但末次随访时上升到14.0%±14.9%(F=6.915,P<0.001)。颈椎曲度方面,C 2~C 7 Cobb角由术前的14.8°±9.1°下降到11.1°±10.5°,至末次随访时维持在11.0°±10.1°(F=1.083,P=0.342)。颈椎活动度术后下降明显,主要是前屈时颈椎活动明显受限,前屈位C 2~C 7 Cobb角由术前的-19.8°±13.6°下降至末次随访时的-3.7°±10.6°(P<0.001)。共72例(44.0%)术后发生并发症。6例(3.6%)患者在随访期间出现神经症状加重,mJOA评分下降3分以上。62例(37.6%)患者出现轴性症状,7例在术后6个月内得到缓解,余55例患者症状持续至末次随访,其中17例(10.3%)疼痛较为明显。术后出现C 5神经根麻痹者10例(6.1%),9例在术后2年内缓解,余1例患者末次随访时仍未恢复。结论:改良SLAC手术能够有效的缓解患者神经症状,并长期维持疗效和颈椎前凸曲度。术后持续轴性症状的发生以及颈椎前屈活动度的丢失是SLAC手术术后长期随访的主要并发症。Objective To explore the long-term clinical efficacy and complications of modified spinous process splitting laminoplasty using coralline hydroxyapatite(SLAC).Methods The patients who underwent SLAC surgery in this hospital from 2005.5 to 2011.7 were included retrospectively.The perioperative data were collected and followed up.A total of 165 cases were included.Among them,there were 115 males and 50 females;the average age was 56.5±11.4 years(range:26-84 years),and the average follow-up period was 136.5±23.2 months(range:108-182 months).The modified Japanese Orthopedic Association(mJOA)score,the neck disability index(NDI)score were used to evaluate the clinical symptoms of patients,and follow-up imaging to observe the changes in cervical spine curvature and mobility.Results In terms of functional score:mJOA score increased from 11.4±2.9 before surgery to 15.0±1.8 in the early postoperative period but dropped to 14.0±2.5 at the last follow-up(F=77.096,P<0.001),and NDI score decreased from 19.2%±14.4%before surgery to 13.0%±15.0%in the early postoperative period,but it rose to 14.0%±14.9%at the last follow-up(F=6.915,P<0.001).The improvement rate of mJOA was 63.5%(early postoperatively)and 50.8%(last follow-up).Regarding the curvature of the cervical spine,the C2-C7 Cobb angle decreased from 14.8°±9.1°before surgery to 11.1°±10.5°,and it was maintained at the last follow-up(11.0°±10.1°)(F=1.083,P=0.342).The cervical spine range of motion decreased significantly,mainly because the Cobb angle in the flexion position decreased from-19.8°±13.6°before the operation to-3.7°±10.6°at the last follow-up(P<0.001).Seventy-two patients(44.0%)had complications after operation.Six patients(3.6%)developed neurological symptoms aggravated during follow-up,and their mJOA decreased by more than 3 points.62 patients(37.6%)developed axial symptoms,of which 7 cases were relieved early(within 6 months post-op),55 patients had persisted symptom and 17 cases(10.3%)remained painful.C5 nerve root palsy occurred in 10

关 键 词：颈椎 椎管狭窄 后纵韧带骨化 随访研究 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]