颈椎后路椎管扩大椎板成形术后手术与未手术交界区脊髓漂移角度的研究  

A study on spinal cord drift angle of surgical and non-surgical junction area after posterior cervical laminoplasty

作　　者：沈晓龙 魏磊鑫 吴卉乔 钟华建 王睿哲 王新伟 刘洋 陈华江 徐辰 袁文 Shen Xiaoong;Wei Leixin;Wu Huiqiao;Zhong Huajian;Wang Ruizhe;Wang Xinwei;Liu Yang;Chen Huajiang;XuChen;Yuan Wen(Department of Orthopaedics,Changzheng Hospital,Naval Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学长征医院骨科,上海200003

出　　处：《脊柱外科杂志》2024年第4期217-221,共5页Journal of Spinal Surgery

基　　金：国家自然科学基金面上项目(82072471);上海市科学技术委员会科技计划项目(23ZR1478000)。

摘　　要：目的 探讨颈椎后路椎管扩大椎板成形术后手术与未手术交界区脊髓漂移角度的变化情况。方法 回顾性分析2020年12月—2022年12月采用单侧显露通道技术椎管扩大椎板成形术治疗的69例颈椎后纵韧带骨化症患者的临床资料,测量并比较头、尾端交界区脊髓漂移角在手术前后的变化。于术前、术后即刻、术后2个月、末次随访时采用疼痛视觉模拟量表(VAS)评分评估颈部疼痛程度,采用颈椎功能障碍指数(NDI)和日本骨科学会(JOA)评分评估神经功能状况。结果 所有手术顺利完成,患者随访12 ~ 36(18.7±5.8)个月。术后脊髓均向后漂移,术后各随访时间点头、尾端交界区脊髓漂移角较术前明显增大,差异均有统计学意义(P < 0.05)。术后2个月、末次随访时VAS评分较术前明显改善,术后各随访时间点NDI及JOA评分较术前明显改善,差异均有统计学意义(P < 0.05)。结论 颈椎后路椎管扩大椎板成形术后脊髓向后方漂移,交界区脊髓漂移角较术前进一步增大,如术前交界区脊髓漂移角已经较大,建议延长手术节段。Objective To explorethechangesin spinal cord drit angleof thesurgical and non-surgical junction areaafter posterior cervical laminoplasty.Methods The clinical data of 69 patients with cervical ossification of the posterior longitudinal ligament treated with laminoplasty by unilateral exposure channel technique from December 2020 to December 2022 were retrospectively analyzed.The changes of cephalic and caudal spinal cord drft angle at the junction area before and after surgery were measured and compared.At pre-operation,immediately after operation,postoperative 2 months and thefinalfollow-up the intensity of neck pain was assessed by visual analogue scale(VAS)score,and the neurological status was assessed by cervical spine neck disability index(NDI)and Japanese Orthopaedic Association(JOA)score.Results All theoperations were successfully completed and the patients were followed up for 12-36(18.7±5.8)months.The spinal cord drifted backward after the operation,and the cephalic and caudal spinal cord drift angles at the junction area were significantly increased at each follow-up time point,all with a statistical significance(P<0.05).The VAS score of neck pain was significantly improved at postoperative 2 months and the final follow-up,and the NDI and JOA score were significantly improved at each follow-up time point,all with a statistical significance(P<0.05).Conclusions After laminoplasty,the spinal cord could drift backwards,and spinal cord drift angle at the junction area could further increase compared to before surgery.If the spinal cord drift angle at the junction area is already large before surgery,it is recommended to extend the surgical segment.

关 键 词：颈椎 骨化 后纵韧带 椎板成形术 减压术 外科 

分 类 号：R681.531[医药卫生—骨科学]