颈后路单侧显露选择性通道辅助下椎管扩大椎板成形术治疗多节段颈椎退行性疾病的疗效观察  

The effect of posterior unilateral exposure and selective channel-assisted laminoplasty in the treatment of multilevel degenerative cervical spondylosis

作　　者：沈晓龙 魏磊鑫 徐辰 钟华建 王睿哲 张子凡 刘洋 王新伟 陈华江 吴卉乔 袁文 SHEN Xiaolong;WEI Leixin;XU Chen(Department of Orthopedics,the Second Affiliated Hospital of Naval Medical University,Shanghai,200003,China)

机构地区：[1]海军军医大学第二附属医院骨科,上海市200003

出　　处：《中国脊柱脊髓杂志》2023年第2期104-114,共11页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:评价颈后路单侧显露选择性通道辅助下椎管扩大椎板成形术(selective channel-assisted laminoplasty,SCA-LP)治疗多节段颈椎行性疾病的安全性与有效性,并对比3种颈椎后路单开门椎管扩大椎板成形术(laminoplasty,LP)的临床疗效。方法:回顾性分析2020年3月~2021年7月共114例行颈后路LP的患者资料,其中男62例、女52例,年龄58.27±7.36岁。其中多节段脊髓型颈椎病52例、颈椎管狭窄症25例、颈椎后纵韧带骨化症37例。39例患者接受了颈后路单侧显露SCA-LP,33例患者接受了颈后路单侧显露完全保留对侧椎旁肌的椎管扩大椎板成形术(muscle-preserved laminoplasty,MP-LP),42例患者接受了常规的颈后路单开门LP。随访12~28个月(18.46±5.75个月)。比较三组患者的年龄、性别、体重指数(body mass index,BMI)。记录并比较三组的手术时间、术中出血量、术后引流量及平均住院日。于术前、术后即刻、术后2个月、术后12个月及末次随访时采用疼痛视觉模拟量表(visual analog scale,VAS)评分评估颈部和上肢疼痛程度,颈椎功能障碍指数(neck disability index,NDI)评价患者颈椎功能,日本骨科学会(Japanese Orthopedic Association,JOA)评分评估神经功能状况。在术前、术后即刻、术后2个月、术后12个月及末次随访时的颈椎侧位X线片上测量C2-C7 Cobb角、CT横断面上测量骨性椎管面积,比较三种手术方法对C2-C7 Cobb角的影响及椎管面积的增加程度(比较每个节段的增加程度及每例患者的平均增加程度)。结果:三组患者的年龄、性别、BMI差异无统计学意义(P>0.05)。所有患者均顺利完成手术,术后均未发生神经损伤、感染等并发症。手术时间及平均住院日MP-LP组均最短、SCA-LP组次之、LP组最长,术中出血量及术后引流量MP-LP组均最少、SCA-LP组次之、LP组最多,三组间的差异均有统计学意义(P<0.05)。三组患者术后各时间点NDI及JOA评分均较术�Objectives:To evaluate the clinical safety and effectiveness of posterior unilateral exposure and selective channel-assisted laminoplasty(SCA-LP)in the treatment of multi-level degenerative cervical spondylosis and to compare the clinical outcomes of three types of posterior open-door laminoplasty.Methods:A total of 114 patients underwent posterior laminoplasty(LP)from March 2020 to July 2021 were analyzed retrospectively,including 62 males and 52 females,with an average age of 58.27±7.36 years.Among them,there were 52 cases of multilevel cervical spondylotic myelopathy(MCSM),25 cases of cervical canal stenosis(CCS),and 37 cases of ossification of posterior longitudinal ligament(OPLL).39 patients received unilateral exposure and SCA-LP(SCA-LP group),33 patients received unilateral exposure and contralateral paravertebral musle-preserved(MP)LP(MP-LP group)and 42 patients were treated with traditional open-door LP(LP group).The patients were followed up for 12-28 months(18.46±5.75 months).Patient characteristics such as age,gender and body mass index(BMI)were compared between groups.Surgical parameters such as the operative time,blood loss,amount of post-operative drainage,and average length of hospital stay were collected and compared.At before operation,immediately after operation,2 and 12 months postoperatively,and final follow-up,clnical parameters such as visual analog scale(VAS)assessing neck and arm pains,neck disability index(NDI)assessing cervical function and Japanese Orthopedic Association(JOA)scores assessing neurological status were recorded and compared between groups respectively;and C2-C7 Cobb angle and the cross-sectional area of spinal canal were measured on lateral X-ray films of cervical spine to compare the effects of the three surgical methods on C2-C7 Cobb angle and the increase of spinal canal area(the increase of each segment and the average increase of each patient).Results:There were no significant differences in age,gender and BMI between the three groups(P>0.05).All patients underwent

关 键 词：椎管扩大椎板成形术 选择性通道辅助 单侧显露 疗效 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]