保留棘突的颈椎后路单开门椎管扩大成形术治疗脊髓型颈椎病  

The clinical effect of spinal process-preserving posterior approach with single open door spinal canal enlargement for the treatment of cervical spondylotic myelopathy

作　　者：赵国权 陆廷盛 姚书眈 蒲兴魏 罗春山 ZHAO Guoquan;LU Tingsheng;YAO Shudan;PU Xingwei;LUO Chunshan(Guizhou Orthopaedic Hospital, Guiyang 550002, China)

机构地区：[1]贵州省骨科医院,贵州贵阳550002

出　　处：《西部医学》2021年第8期1184-1188,共5页Medical Journal of West China

基　　金：贵州省科技计划项目[黔科合基础(2019)1183号]。

摘　　要：目的对比保留棘突的颈椎后路单开门椎管扩大成形术与传统颈椎后路单开门椎管扩大成形术治疗脊髓型颈椎病的疗效。方法回顾性分析我院2016年7月~2019年1月收治的62例脊髓型颈椎病患者临床资料,按手术方式分为改良组与对照组。改良组患者采用保留棘突的颈椎后路单开门椎管扩大成形手术,对照组患者选取传统不保留棘突的颈椎后路单开门椎管扩大成形手术。记录并对比分析两组患者的手术时间、术中出血量(术中出血量+术后伤口引流量)、轴性症状发生情况;分析比较两组术前及随访时的颈椎日本骨科学会(JOA)评分和改善率。结果所有患者手术顺利,随访6~25个月;两组手术时间相比,差异无统计学意义(P>0.05);改良组出血量少于对照组(P<0.05);末次随访时,两组患者JOA评分与同组术前比较,差异无统计学意义(均P>0.05);改良组术后出现7例轴性症状,对照组出现8例轴性症状,均经过保守治疗后症状缓解,两组比较差异无统计学意义(P>0.05)。结论保留棘突的颈椎后路单开门椎管扩大成形术与传统颈椎后路单开门椎管扩大成形术在治疗脊髓型颈椎病方面相比,同样能获得有效的脊髓减压,取得良好的临床效果以及较少的并发症,且保留棘突的颈椎后路单开门术能够降低出血量及简化手术步骤,更具有临床应用价值。Objective To evaluate the evaluation of posterior cervical open-door laminoplasty with conventional spinous processes and conventional cervical spine the efficacy of single-door open-door laminoplasty for the treatment of cervical spondylotic myelopathy.Methods The clinical data of 62 patients with cervical spondylotic myelopathy treated in our hospital from July 2016 to January 2019 were retrospectively analyzed.They were divided into the improved group and the control group according to the operation method.The patients in the improved group were treated with single open-door laminoplasty with spinous process preserved,while the patients in the control group were treated with traditional single open-door laminoplasty without spinous process preserved.The operation time,intraoperative blood loss(intraoperative blood loss+postoperative wound drainage)and axial symptoms of the two groups were recorded and compared;The Japanese Orthopaedic Association(JOA)score and improvement rate of cervical spine were analyzed and compared between the two groups.Results All patients were followed up for 6 to 25 months.There was no significant difference in operation time between the two groups(P>0.05).At the last follow-up,the JOA score of the two groups was significantly improved compared with that of the same group before operation,and the difference was not statistically significant(all P>0.05).There were 7 cases of axial symptoms in the improved group and 8 cases in the control group.The symptoms were relieved after conservative treatment.There was no significant difference between the two groups(P>0.05).Conclusion Compared with the traditional open-door laminoplasty in the treatment of cervical spondylotic myelopathy,spine preserving open-door laminoplasty can also obtain effective spinal cord decompression,achieve good clinical effect and less complications,and spine preserving open-door laminoplasty can reduce the amount of bleeding and simplify the operation steps.

关 键 词：保留棘突 颈椎后路单开门椎管扩大成形术 脊髓型颈椎病 出血量 

分 类 号：R681[医药卫生—骨科学]