后路单开门椎管扩大成形术治疗伴或不伴脊髓—椎管不匹配颈椎过伸性损伤的疗效评价  

Efficacy of open-door laminoplasty for cervical hyperextension injury accompanied with or without spinal cord-canal mismatch

作　　者：张凯[1,2] 王昕 杨二柱[1,2] 孙晓江 程晓非 田海军[1,2] 赵长清 赵杰 Zhang Kai;Wang Xin;Yang Erzhu;Sun Xioojiung;Cheng Xiaofei;Tian Haijun;Zhao Changqing;Zhao Jie(Depurtment of Orthopedic Surgery,Shanghai Ninth People's Hospital,Shanghai Jiaotong Unirersily School of Medicine,Shanghai 200011,China;Shanghai Key Laboralory of Orthopedic Implants,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院骨科,200011 [2]上海市骨科内植物重点实验室,200011

出　　处：《中华创伤杂志》2021年第8期720-725,共6页Chinese Journal of Trauma

基　　金：国家重点研发汁划重点专项课题(2017YFBI104104)。

摘　　要：目的:探讨后路单开门椎管扩大成形术治疗伴或不伴脊髓-椎管不匹配的颈椎过伸性损伤的临床疗效。方法:采用回顾性病例对照研究分析2016年1月至2019年6月上海交通大学医学院附属第九人民医院治疗的42例颈椎过伸性损伤患者的临床资料,其中男31例,女11例;年龄40~78岁[(59.7 ± 9.9)岁]。患者均接受颈后路单开门椎管扩大成形术。术前日本骨科学会(JOA)评分为(10.2 ± 3.8)分,美国脊髓损伤协会(ASIA)脊髓损伤总分为(260.4 ± 47.5)分。将脊髓椎管占有率(SCOR)≥ 70%者归为脊髓-椎管不匹配组(不匹配组,21例),SCOR < 70%者归为脊髓-椎管匹配组(匹配组,21例)。比较两组术前、术后1周及末次随访时ASIA总分、ASIA上肢及下肢运动评分、ASIA感觉评分、JOA评分和手术改善率及并发症发生情况。结果:患者均获随访12~26个月[(19.1 ± 2.3)个月]。两组术后1周及末次随访时ASIA总分均较术前明显改善( P < 0.05)。术后1周两组ASIA总分差异无统计学意义( P > 0.05)。末次随访时不匹配组ASIA总分为(307.6 ± 9.9)分,明显低于匹配组的(315.4 ± 8.7)分( P < 0.01)。术后1周及末次随访时不匹配组ASIA上肢运动评分分别为(29.1 ± 7.0)分、(36.6 ± 6.5)分,均明显低于匹配组的(42.0 ± 5.7)分、(47.4 ± 2.5)分( P < 0.01)。而术后1周及末次随访时两组间ASIA下肢运动评分和感觉评分差异无统计学意义( P > 0.05)。两组术后1周及末次随访时JOA评分均较术前明显改善( P < 0.05)。不匹配组术后1周及末次随访时JOA评分分别为(11.5 ± 3.0)分和(12.5 ± 3.0)分,均明显低于匹配组的(13.5 ± 2.4)分和(15.0 ± 2.0)分( P < 0.01)。匹配组手术改善率为95%(20/21),不匹配组为85%(18/21)( P < 0.05)。两组各出现3例颈部轴性痛,匹配组出现2例C 5神经根麻痹,均经非手术治疗后缓解。随访期间两组患者均未发生内固定松动或断裂。 结论:后路单开门椎管扩大成形术可改善颈椎Objective:To explore the clinical efficacy of open-door laminoplasty in treatment of cervical spinal hyperextension injury accompanied with or without spinal cord-canal mismatch.Methods:A retrospective case-control study was performed to analyze the clinical data of 42 patients with cervical spine hyperextension in Shanghai Ninth People’s Hospital,Shanghai Jiaotong University School of Medicine from January 2016 to June 2019. There were 31 males and 11 females at age range of 40-78 years[(59.7 ± 9.9)years]. All patients underwent open-door laminoplasty.Preoperative Japanese Orthopaedic Association score(JOA)was(10.2 ± 3.8)points,and American Spinal Injury Association(ASIA)spinal cord injury score was(260.4 ± 47.5)points. Those with spinal cord occupation rate(SCOR)equal to or more than 70% were classified as spinal cord-canal mismatched group(n=21),and those with SCOR less than 70% were classified as spinal cord-canal matched group(n=21). ASIA total score,ASIA upper and lower limb motor scores,ASIA sensory score,JOA score,surgical improvement rates and complications were compared between the two groups before operation,at postoperative one week and at the latest follow-up.Results:All patients were followed up for 12-26 months[(19.1 ± 2.3)months]. Both groups had significantly improved ASIA total score at postoperative one week and at the latest follow-up,compared with that before operation( P < 0.05). The two groups showed no significant difference in ASIA total score at postoperative one week( P > 0.05). ASIA total score in unmatched group was(307.6 ± 9.9)points at the latest follow-up,significantly lower than that in matched group[(315.4 ± 8.7)points]( P < 0.01). ASIA upper limb motor score in mismatched group was(29.1 ± 7.0)points and(36.6 ± 6.5)points at postoperative one week and at the latest follow-up,significantly lower than that in matched group[(42.0 ± 5.7)points,(47.4 ± 2.5)points]( P < 0.01),while there was no significant difference in ASIA lower limb motor score and sensory score between

关 键 词：颈椎 颈椎飞鞭损伤 椎板成形术 

分 类 号：R687.3[医药卫生—骨科学]