O形臂导航辅助与常规肌间隙入路颈椎后路单开门椎管扩大成形术治疗无骨折脱位型颈脊髓损伤的疗效比较  

Comparative efficacy of O-arm navigation-assisted and conventional posterior cervical expansive open-door laminoplasty via the intermuscular approach in the treatment of cervical spinal cord injury without fracture-dislocation

作　　者：邵哲 姜文涛[1] 苏锴 郭润栋[1] 王龙[1] 李毅力 李骁腾 潘强强 梅伟[1] 王庆德[1] Shao Zhe;Jiang Wentao;Su Kai;Guo Rundong;Wang Long;Li Yili;Li Xiaoteng;Pan Qiangqiang;Mei Wei;Wang Qingde(Department of Spine and Orthopedics,Zhengzhou Orthopedic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州市骨科医院脊柱骨科,郑州450052

出　　处：《中华创伤杂志》2025年第3期259-266,共8页Chinese Journal of Trauma

基　　金：郑州市医疗卫生领域科技创新指导计划项目(2024YLZDJH191)。

摘　　要：目的比较O形臂导航辅助与常规肌间隙入路颈椎后路单开门椎管扩大成形术(CEOL)治疗无骨折脱位型颈脊髓损伤(CSCIWFD)的疗效。方法采用前瞻性队列研究分析2021年5月至2023年5月郑州市骨科医院收治的60例CSCIWFD患者的临床资料,压迫节段均为C_(3)~C_(6)。按随机数字表法将患者分为2组:30例采用O形臂导航辅助肌间隙入路CEOL治疗(导航辅助组),30例采用常规肌间隙入路CEOL治疗(常规手术组)。比较2组手术时长、术中失血量、术后引流量、手术总失血量。术后2周复查CT评估2组手术节段门轴或开门位置制备准确率。比较2组术前和术后2周、6个月及末次随访时颈肩部视觉模拟评分(VAS)与日本骨科学会(JOA)评分;并发症发生率。结果共纳入CSCIWFD患者60例,其中男35例,女25例;年龄35~77岁[(50.9±8.6)岁]。患者均获随访12~24个月[(16.9±3.1)个月]。导航辅助组手术时长、术中失血量分别为(121.6±17.9)min、(144.7±44.2)ml,均低于常规手术组的(132.3±14.6)min、(178.7±48.7)ml(P<0.05);而2组术后引流量、手术总失血量比较,差异均无统计学意义(P>0.05)。术后2周复查CT显示,导航辅助组手术节段门轴或开门位置制备准确率为99.2%(119/120),高于常规手术组的86.7%(104/120)(P<0.01)。术前和术后2周、6个月及末次随访时,导航辅助组颈肩部VAS分别为5.0(4.0,7.0)分、3.0(2.0,4.0)分、2.0(1.0,2.0)分、1.0(1.0,2.0)分,JOA评分分别为(8.7±2.8)分、(10.2±2.5)分、(13.0±1.8)分、(13.9±1.5)分;常规手术组颈肩部VAS分别为5.5(5.0,6.3)分、4.0(3.0,4.0)分、2.0(1.0,3.0)分、2.0(1.0,2.0)分,JOA评分分别为(8.8±2.6)分、(10.4±2.5)分、(12.9±2.2)分、(13.8±2.0)分(P>0.05)。2组术后2周、6个月及末次随访时颈肩部VAS、JOA评分均较术前改善(P<0.05);术后6个月及末次随访时颈肩部VAS、JOA评分均较术后2周进一步改善(P<0.05);术后6个月与末次随访时,颈肩部VAS、JOA评分差异均无统计学Objective To compare the efficacy of O-arm navigation-assisted and conventional posterior cervical expansive open-door laminoplasty(CEOL)via the intermuscular approach in the treatment of cervical spinal cord injury without fracture-dislocation(CSCIWFD).Methods A prospective cohort study was conducted to analyze the clinical data of 60 CSCIWFD patients who were admitted to Zhengzhou Orthopedic Hospital from May 2021 to May 2023,with compression at C_(3)-C_(6).Patients were randomly divided into two groups:30 patients underwent O-arm navigation-assisted intermuscular approach CEOL(navigation-assisted group)and 30 patients underwent conventional intermuscular approach CEOL(conventional surgery group).Surgical duration,intraoperative blood loss,postoperative drainage volume,and total surgical blood loss were compared between the two groups.At 2 weeks postoperatively,CT scan was performed to evaluate the accuracy of hinge or open-door position preparation of the surgical segments.Visual analogue scale(VAS)for neck and shoulder pain and Japanese Orthopedic Association(JOA)scores were compared between the two groups preoperatively,at 2 weeks,6 months postoperatively,and at the last follow-up.Complication rates were also evaluated.Results A total of 60 patients with CSCIWFD were included,comprising 35 males and 25 females,aged 35-77 years[(50.9±8.6)years].All the patients were followed up for 12-24 months[(16.9±3.1)months].The surgical duration and intraoperative blood loss were(121.6±17.9)minutes and(144.7±44.2)ml in the navigation-assisted group,shorter or less than(132.3±14.6)minutes and(178.7±48.7)ml in the conventional surgery group(P<0.05).There were no statistically significant differences in postoperative drainage volume and total surgical blood loss between the two groups(P>0.05).CT scan reviewed at 2 weeks postoperatively revealed that the accuracy rate of hinge and open-door position preparation of the surgical segments in the navigation-assisted group was 99.2%(119/120),significantly higher than 86.7%(

关 键 词：颈椎 脊髓损伤 骨折固定术 髓内 肌间隙入路 

分 类 号：R681.5[医药卫生—骨科学] R744.2[医药卫生—外科学] R615[医药卫生—临床医学]