颈椎椎板成形术对脊柱矢状位平衡的影响  

Effect of cervical laminoplasty on spinal sagittal balance

作　　者：唐冲[1,2] 周非非[1] 李危石[1] Tang Chong;Zhou Feifei;Li Weishi(Department of Orthopedics,Peking University Third Hospital,Beijing 100089,China;Department of Orthopedics,Peking University Shougang Hospital,Beijing 100144,China)

机构地区：[1]北京大学第三医院骨科,北京100191 [2]北京大学首钢医院骨科,北京100144

出　　处：《中华临床医师杂志(电子版)》2024年第11期1066-1069,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：颈椎椎板成形术通过扩大骨性椎管的面积,增加椎管的有效空间,使颈脊髓向后漂移,从而实现对颈脊髓的间接减压,缓解临床症状。这是一种常用的治疗多节段脊髓型颈椎病和颈椎后纵韧带骨化症的手术方式。经过近半个世纪的发展,颈椎椎板成形术已经演变出多种改良术式,且手术疗效得到了肯定,远期效果令人满意。然而,该手术需要部分剥离颈椎后方的椎旁肌,破坏颈椎的骨性结构及棘突-肌肉-韧带复合体,导致颈椎后柱结构在传递和分担荷载方面的功能部分丧失,难以维持术后颈椎的新矢状位平衡,从而为了减少颈部后方肌群的负荷消耗,颈椎重心前移,加速了颈椎局部力学失衡。本综述重点总结了颈椎椎板成形术对颈椎矢状位平衡的影响及其一系列代偿机制,并展望了该手术对全脊柱及脊柱-骨盆矢状位平衡影响及代偿机制研究的前景,为今后的临床治疗方案选择提供理论依据。Cervical laminoplasty can make the cervical spinal cord drift backward by expanding the area of the bony spinal canal and increasing the effective space of the spinal canal,so as to achieve indirect decompression of the cervical spinal cord and relieve the clinical symptoms.It is a common surgical procedure for the treatment of multilevel cervical spondylotic myelopathy and cervical ossification of the posterior longitudinal ligament.After nearly half a century of development,there has been a variety of improved cervical laminoplasty methods,resulting in positive surgical outcomes and satisfactory long-term results.However,cervical laminoplasty requires partial dissection of the cervical paraspinal muscles,which destroys the cervical bone structure and spinous process-muscle-ligament complex,resulting in partial loss of the function of the posterior column of the cervical spine to transfer and share load.It is difficult to maintain the new cervical sagittal balance after laminoplasty.In order to reduce the load consumption of the posterior cervical muscles,the gravity of the cervical spine moves forward,which accelerates the local cervical sagittal imbalance.This review focuses on the effects of cervical laminoplasty on cervical sagittal alignment and the subsequent compensatory mechanisms,and discusses the prospects for research on the effects of cervical laminoplasty on the whole spine and spinal-pelvic sagittal balance and relevant compensatory mechanisms,with an aim to provide a theoretical basis for the clinical treatment decision in the future.

关 键 词：颈椎椎板成形术 矢状位平衡 矢状面轴向距离 T1倾斜角 T1脊柱骨盆倾斜角 

分 类 号：R687.3[医药卫生—骨科学]