颈椎后路单侧显露椎管扩大椎板成形术治疗颈椎后路单开门椎管扩大椎板成形术后的骨化进展  

Posterior cervical unilaterally exposed spinal laminoplasty for treatment of ossification progression after posterior cervical single-door laminoplasty

作　　者：沈晓龙 徐辰 钟华建 王睿哲 张子凡 文国庆 吴卉乔 刘洋 王新伟 陈华江 魏磊鑫 袁文 Shen Xiaolong;Xu Chen;Zhong Huajian;Wang Ruizhe;Zhang Zifan;Wen Guoqing;Wu Huiqiao;Liu Yang;Wang Xinwei;Chen Huajiang;Wei Leixin;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5期289-294,共6页Journal of Spinal Surgery

基　　金：国家自然科学基金面上项目(81772376,82072471);上海市科学技术委员会科技计划项目(23ZR1478000)。

摘　　要：目的探讨采用颈椎后路单侧显露椎管扩大椎板成形术治疗颈椎后路单开门椎管扩大椎板成形术后骨化进展的可行性和有效性。方法2021年6月—2023年3月,采用颈椎后路单侧显露椎管扩大椎板成形术治疗颈椎后路单开门椎管扩大椎板成形术后骨化进展患者12例。记录翻修手术的手术时间、术中出血量、术后引流量及手术并发症情况。于术前、术后12个月及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)评价颈椎功能;采用日本骨科学会(JOA)评分评估神经功能状况。测量术前、术后12个月及末次随访时C_(2~7)Cobb角、颈椎活动度(ROM)、T1倾斜角、C_(2~7)矢状面平衡(SVA)及椎管横截面积。结果所有手术顺利完成,所有患者均未发生明显神经损伤、深部感染等严重并发症。手术时间为(105.38±19.06)min,术中出血量为(128.44±33.62)mL,术后引流量为(142.51±25.38)mL。所有患者随访12~33(22.64±6.72)个月。翻修术后12个月、末次随访VAS评分、NDI及JOA评分较术前明显改善,差异均有统计学意义(P<0.05)。翻修术后12个月、末次随访时C_(2~7)Cobb角、ROM、T1倾斜角及C_(2~7)SVA较术前无明显变化,差异无统计学意义(P>0.05)。翻修术后12个月、末次随访时椎管横截面积较术前明显增加,差异均有统计学意义(P<0.05)。随访中无钛板断裂等严重内置物并发症发生。结论采用颈椎后路单侧显露椎管扩大椎板成形术治疗颈椎后路单开门椎管扩大椎板成形术后的骨化进展安全、有效。翻修手术明显改善了患者的神经功能、保留了颈椎ROM。Objective To explore the feasibility and effectiveness of using posterior cervical unilaterally exposed laminoplasty to revise the ossification progression after posterior cervical single-door laminoplasty.Methods From June 2021 to March 2023,12 patients of ossification progression after single-door laminoplasty were treated by posterior cervical unilaterally exposed laminoplasty.The operation time,intraoperative blood loss,postoperative drainage volume and complications were recorded.At pre-operation,postoperative 12 months and the final follow-up,the visual analogue scale(VAS)score was used to evaluate the intensity of neck pain,and the neck disability index(NDI)was used to evaluate the cervical function,and the Japanese Orthopedic Association(JOA)score was used to evaluate the neurological function.The C_(2-7)Cobb angle,range of motion(ROM),T1 slope,C_(2-7)sagittal vertical axis(SVA)and cross-sectional area of spinal canal were measured.Results All the operations were successfully completed.No postoperative complications such as nerve injury and infection occurred.The operation time was(105.38±19.06)min,the intraoperative blood loss was(128.44±33.62)mL,and the postoperative drainage volume was(142.51±25.38)mL.All the patients were followed up for 12-33(22.64±6.72)months.The VAS scores,NDI and JOA scores of the patients at postoperative 12 months and the final follow-up showed significant improvement compared with those at pre-operation,all with a statistical significance difference(P<0.05).There were no significant differences in the C_(2-7)Cobb angle,ROM,T1 slope,and C_(2-7)SVA at postoperative 12 months and the final follow-up compared with those at pre-operation(P>0.05).The cross-sectional area of spinal canal at postoperative 12 months and the final follow-up showed a significant increase compared with those at pre-operation,all with a statistical significance difference(P<0.05).No serious implant complications such as titanium plate fracture or displacement occurred during the follow-up.Conclusions As

关 键 词：颈椎 骨化 后纵韧带 减压术 外科 再手术 

分 类 号：R681.531[医药卫生—骨科学]