后路半椎板与全椎板切除术治疗无骨折脱位颈椎脊髓损伤  

Posterior semi-laminectomy and total laminectomy for cervical spinal cord injury without fracture and dislocation

作　　者：林松 陈钱 陈洪柱 苗吉显 郭明伟 吴强 Lin Song;Chen Qian;Chen Hongzhu;Miao Jixian;Guo Mingwei;Wu Qiang(Department of Orthopaedics,Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincal Orthopedic Hospital),Zhengzhou 450000,Henan,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)脊柱外科,郑州450000

出　　处：《脊柱外科杂志》2023年第6期381-385,共5页Journal of Spinal Surgery

摘　　要：目的比较后路半椎板切除术与全椎板切除术治疗无骨折脱位颈椎脊髓损伤的临床疗效。方法2015年6月—2021年8月收治无骨折脱位颈椎脊髓损伤患者83例,其中采用半椎板切除术治疗42例(半椎板切除组)、采用全椎板切除术治疗41例(全椎板切除组)。记录2组手术时间、术中出血量、住院时间、术后引流量及C5神经根麻痹和轴性痛等并发症发生情况。测量患者脊髓水肿或受压最重层面脊髓正中矢状径和横截面积以及总植骨床面积。采用日本骨科学会(JOA)评分和美国脊髓损伤协会(ASIA)分级评估临床效果。结果所有手术顺利完成,随访时间≥6个月。2组手术时间和住院时间差异无统计学意义(P>0.05);半椎板切除组术中出血量、术后引流量少于全椎板切除组,差异均有统计学意义(P<0.05)。末次随访时2组JOA评分、ASIA分级、脊髓水肿或受压最重层面脊髓正中矢状径和横截面积较术前显著改善,差异均有统计学意义(P<0.05);组间差异无统计学意义(P>0.05)。半椎板切除组植骨床总面积为(8.85±1.42)cm2,全椎板切除组为(5.06±0.71)cm2,半椎板切除组植骨床总表面积约是全椎板切除组的1.75倍。2组术后C5神经根麻痹发生率相似(4.8%vs.7.3%),但全椎板切除组术后轴性痛发生率(17.1%)显著高于半椎板切除组(7.1%),差异有统计学意义(P<0.05)。结论后路半椎板切除术与全椎板切除术治疗无骨折脱位颈椎脊髓损伤均可获得满意的临床疗效,但半椎板切除创伤小、术中出血量少、轴性痛发生率低且保留了对侧椎板充当广泛植骨床而更具优势。Objective To compare the clinical effects of posterior semi-laminectomy with total laminectomy in the treatment of cervical spinal cord injury without fracture and dislocation.Methods From June 2015 to August 2021,83 patients with cervical spinal cord injury without fracture and dislocation were treated,including 42 with semi-laminectomy(semi-laminectomy group)and 41 with total laminectomy(total laminectomy group).The operation time,intraoperative blood loss,hospital stay,postoperative drainage volume,C5 nerve root palsy and axial pain were recorded.The midsagittal diameter and cross-sectional area of cervical spinal cord at the most severe level of edema or compression and the total area of the bone graft were measured.The Japanese Orthopaedic Association(JOA)score and the American Spinal Cord Injury Association(ASIA)classification were used to evaluate the clinical outcome.Results All the patients successfully completed the operation,and the follow-up time was more than 6 months.There was no significant difference between the 2 groups in operation time and hospital stay(P>0.05).The intraoperative blood loss and postoperative drainage volume in the semi-laminectomy group were less than those in the total laminectomy group,and the differences were statistically significan(t P<0.05).At the final follow-up,the JOA score,ASIA classification,midsagittal diameter and cross-sectional area of cervical spinal cord at the most severe level of edema or compression in the 2 groups were significantly improved compared with those before surgery,all with a statistical significance(P<0.05),but there was no statistically significant difference between the 2 groups(P>0.05).The total area of the bone graft in the semi-laminectomy group was(8.85±1.42)cm2,and(5.06±0.71)cm2 in the total laminectomy group.The total area of the bone graft in the semi-laminectomy group was about 1.75 times of the total laminectomy group.The incidence of C5 nerve root palsy in the 2 groups was similar(4.8%vs.7.3%),but the incidence of axial pain in the

关 键 词：颈椎 脊髓损伤 减压术 外科 脊柱融合术 内固定器 

分 类 号：R681.531[医药卫生—骨科学]