单开门椎管扩大成形术门轴侧椎板及侧块植骨治疗多节段脊髓型颈椎病的短期疗效  

Short-term efficacy of single open-door laminoplasty and lateral mass bone grafting in the treatment of multilevel cervical spondylotic myelopathy

作　　者：段笑宗 皮国富[1] 王丹[1] 孙建广[1] 潘军伟[1] 毛克亚 刘宏建[1] Duan Xiaozong;Pi Guofu;Wang Dan;Sun Jianguang;Pan Junwei;Mao Keya;Liu Hongjian(Department of Orthopedic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Orthopaedics,the First Medical Centre,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]郑州大学第一附属医院骨科医学部,郑州450052 [2]中国人民解放军总医院第一医学中心骨科,北京100853

出　　处：《中华实验外科杂志》2024年第6期1325-1328,共4页Chinese Journal of Experimental Surgery

摘　　要：目的探讨颈后路单开门椎管扩大成形术门轴侧椎板及侧块植骨治疗多节段脊髓型颈椎病(CSM)的短期疗效。方法收集2021年1月至2022年12月郑州大学第一附属医院骨科收治的行C3-7单开门手术治疗的多节段CSM患者103例,将术中门轴侧未植骨者纳入对照组(53例),门轴侧椎板及侧块植骨者纳入改良组(50例)。记录并分析两组患者的一般资料、手术时间及术中失血量,术前、术后1年日本骨科协会(JOA)评分,术前、术后3个月、术后1年疼痛视觉模拟评分法(VAS)评分,术后颈椎失稳发生率,术后3、6个月椎体融合率,术后颈椎关节活动度(ROM)丢失角度(°),术后并发症发生率。计量资料均符合正态分布,组内和组间比较采用t检验、χ^(2)检验。结果对照组患者年龄、病程、手术时间、术中失血量[(62.17±6.62)岁、(12.74±5.60)月、(107.25±1.18)min、(217.28±41.73)ml]与改良组[(62.72±6.72)岁、(12.76±5.81)月、(108.70±8.11)min、(216.80±45.06)ml]比较,差异无统计学意义(F=0.019、0.022、0.007、0.115,P>0.05)。对照组和改良组患者术后1年JOA评分[(12.79±1.12)、(12.86±1.16)分]均优于术前[(6.47±0.95)、(6.30±1.06)分],差异有统计学意义(t=-48.122、-38.182,P<0.05)。对照组与改良组患者术后1年JOA评分改善率[(60.27±9.10)%比(61.21±9.44)%]比较,差异无统计学意义(F=0.213,P>0.05)。对照组和改良组患者术后1年VAS评分[(1.96±0.80)、(1.34±0.59)分]均优于术前[(5.89±1.25)、(5.92±1.14)分],差异有统计学意义(F=599.207、460.792,P<0.05)。对照组和改良组患者术前VAS评分[(5.89±1.25)分比(5.92±1.14)分]及术后3个月VAS评分[(3.58±1.15)分比(3.68±1.15)分]比较,差异无统计学意义(F=0.003、0.003,P>0.05)。术后1年VAS评分改良组(1.34±0.59)分优于对照组(1.96±0.80)分,差异有统计学意义(F=0.400,P<0.05)。术后1年,对照组颈椎失稳发生率(20.75%)高于改良组(8.00%),差异有统计学意义(χ^(2)=4.769,P<0.05Objective To investigate the short-term efficacy of posterior single-door laminoplasty and lateral mass bone grafting in the treatment of multilevel cervical spondylotic myelopathy(CSM).Methods From January 2021 to December 2022,103 patients with multi-level CSM who underwent C3-7 open-door surgery were collected in the Department of Orthopedic Surgery at the First Affiliated Hospital of Zhengzhou University.Patients with no supplemental bone graft on the axial side of the portal were enrolled in the control group(53 cases),while those with bone graft on the axial side of hinged side were enrolled in the modified group(50 cases).The demographic data,operative time and estimated blood loss during operation were recorded and analyzed.The JOA score was assessed before and 1 year after operation,the visual analogue scale(VAS),the incidence of postoperative cervical spine instability,the fusion rate at 3rd and 6th month postoperatively and,loss of postoperative cervical joint(ROM),postoperative complications were documented.The measurement data were normally distributed.Thet-test andχ^(2)test were used to compare within and between groups.Results There weres no significant differences in age,course of disease,operative time and blood loss during operation between the control group[(62.17±6.62)years,(12.74±5.60)months,(107.25±1.18)min,(217.28±41.73)ml]and the improved group[(62.72±6.72)years,(12.76±5.81)months,(108.70±8.11)min,(216.80±45.06)ml](F=0.019,0.022,0.007,0.115,P>0.05).The JOA scores after operation in the control group and the modified group(12.79±1.12,12.86±1.16)were significantly higher than those preoperation[(6.47±0.95,6.30±1.06),t=-48.122,-38.182,P<0.05].There was no significant difference in the improvement rate of JOA score between the control group and the modified group[(60.27±9.10)%,(61.21±9.44)%,F=0.213,P>0.05].The VAS scores in the control group and the modified group were(1.96±0.80)and(12.86±1.16)respectively one year after operation,which were significantly higher than those bef

关 键 词：颈后路椎管扩大成形术 颈椎失稳 轴性症状 

分 类 号：R687.3[医药卫生—骨科学]