后路椎板成形术与后路椎板切除植骨融合内固定术治疗合并T2加权像高信号改变的长节段脊髓型颈椎的临床疗效  

Comparison of the clinical effects between posterior laminoplasty and posterior laminectomy with bone graft fusion in the treatment of multi-level cervical spondylotic myelopathy with T2-weighted image hyperintensity changes

作　　者：张嘉男 刘团江[1] 杨俊松[1] 刘鹏[1] 田野[1] 黄云飞 郝定均[1] Zhang Jianan;Liu Tuanjiang;Yang Junsong(Lumbar Ward of Spine Hospital,the Affiliated Honghui Hospital of Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院脊柱病医院腰椎病区,710054

出　　处：《美中国际创伤杂志》2021年第2期1-8,共8页U.S.Chinese International Journal of Traumatology

摘　　要：目的:比较评价后路减压植骨融合内固定术与后路椎板成形术治疗伴有T2加权像高信号改变的长节段脊髓型颈椎病的临床疗效。方法:本研究回顾性分析2014年1月至2016年6月在我院行后路椎板成形术治疗的伴有T2加权像高信号改变的长节段脊髓型颈椎病52例(laminoplasty,LP组)。记录日本骨科协会(J0A)评分、视觉模拟量表(VAS)评分、健康调查简表评分(SF-36PCS和SF-36MCS)及颈椎屈伸运动范围(ROMs)。作为对照组,使用7个自变量(术前)进行倾向评分匹配:年龄、性别、J0A评分、SF-36 PCS、SF-36 MCS、术前症状持续时间和高信号强度比,根据倾向评分纳入了2014年1月至2016年6月52例接受后路椎板切除植骨融合内固定术(laminectomy and fusion,LF组)的患者。结果:所有患者均获得随访。LF组和LP组分别随访24〜56个月[(36.41±11.19)个月]和24〜59个月[(34.06±8.31)个月]。两组之间的基线特征没有显著差异。LF组手术时间明显长于LP组。末次随访,两组的J0A评分、VAS评分和SF-36(PCS和MCS)评分均显著改善(P<0.05)。两组的伸屈ROMs均下降,但LP组明显优于LF组(P<0.05)。两组在最后的随访中表现出相似的神经症状改善(P>0.05)。LF组并发症发生率较高(P<0.05)。结论:对于治疗伴有T2加权像高信号改变的长节段脊髓型颈椎病患者,在JOA及SF-36改善方面,后路椎板切除植骨融合内固定术及后路椎板成形术均可取得较好的临床效果,并且没有明显差异。但是,LF组手术时间长,并发症发生率高,颈椎屈伸活动度更低。Objective:This study aimed to compare the clinical outcomes and complications between laminectomy and fusion(LF)and laminoplasty(LP)for multi-level cervical spondylotic myelopathy(MCSM)with increased signal intensity(ISI)on T2-weighted images(T2WI).Methods:In this retrospective cohort study,we analyzed 52 MCSM patients with ISI on T2WI who posterior underwent laminoplasty(LP group).The Japanese orthopedic association(JOA)score,visual analogue scale(VAS)score»physical and mental component scores(PCS and MCS)of short-form 36(SF-36),and the extension and flexion ranges of motion(ROMs)were recorded.As a control group,7 independent variables(preoperation)were used for propensity score matching:age,sex,JOA score,SF-36 PCS,SF-36 MCS,preoperative symptom duration and high signal intensity ratio(HSIR).52 patients who underwent posterior laminectomy and fusion(LF group)were included according to the propensity score from January 2014 to June 2016.Results:All patients were followed up.The LF group and LP group were followed up for 24-56 months[(36.41±11.19)months]and 24-59 months[(34.06±8.31)months],respectively.There were no significant differences in baseline characteristics between the two groups.The operation time of the LF group was significantly longer than that of the LP group.At the last follow-up,the JOA score»VAS score and SF-36(PCS and MCS)scores were all significantly improved in both groups(P<0.05).The extension and flexion ROMs of both groups decreased,but the LP group was significantly better than the LF group(P<0.05).The two groups showed similar improve merit in neurological symptoms during the final follow-up(P>0.05).The incidence of complications was higher in the LF group(P<0.05).Conclusion:For the treatment of long-segment cervical spondylotic myelopathy patients with T2-weighted image hyperintensity changes,in terms of JOA and SF-36 improvement.posterior laminectomy bone graft fusion internal fixation and posterior laminoplasty can be obtained good clinical effect,and there is no obvious difference

关 键 词：脊髓型颈椎病 核磁共振 信号改变 椎板成形术 椎板切除术:融合 

分 类 号：R68[医药卫生—骨科学]