两种手术方式治疗曲度不良性多节段脊髓型颈椎病的比较分析  

Comparative Analysis of Two Surgical Methods for the Treatment of Multi Segmental Cervical Spondylotic Myelopathy with Poor Curvature

作　　者：丁周烨 陈亮[1] 冯煜[1] 蔡峰 汪凌骏 顾勇[1] DING Zhou-ye;CHEN Liang;FENG Yu;CAI Feng;WANG Lin-jun;GU Yong(First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China)

机构地区：[1]苏州大学附属第一医院,江苏苏州215006

出　　处：《中国血液流变学杂志》2024年第4期516-523,F0002,共9页Chinese Journal of Hemorheology

基　　金：国家自然科学基金资助项目(82072438,82272501,82102589,82302683);江苏省自然科学基金项目(BK20211504);江苏省“333工程”人才项目(2069999)。

摘　　要：目的比较颈椎后路单开门椎管成形术(LP)与椎板切除固定减压融合术(LF)治疗曲度不良性多节段脊髓型颈椎病(mCSM)的临床和影像学效果。方法回顾性分析2010年1月—2018年12月73例伴有颈椎曲度不良的mCSM患者,根据手术方式分为LP组(n=41)和LF组(n=32),比较两组矢状面平衡[C_(2-7)前凸角(C_(2-7) CL),C_(2-7)矢状面垂直轴(C_(2-7) SVA),T_(1)倾斜角(T_(1)S)]和疗效[日本骨科协会评分(JOAs),疼痛视觉模拟评分(VAS)]。结果两组患者一般情况、术前矢状面参数、JOAs、VAS及随访时间的差异均无统计学意义(P>0.05)。LF组的手术节段少于LP组,但手术时间、出血量及并发症均多于LP组(P<0.05)。两组患者JOAs术后均显著增加,末次无显著变化,组间差异无统计学意义(P>0.05),JOAs改善率和优良率组间差异均无统计学意义(P>0.05)。两组VAS术后均明显降低,末次显著降低,而LP组低于LF组。两组C_(2-7) CL术后均显著增加,组间差异无统计学意义(P>0.05);末次LP组显著降低,LF组轻度降低,LF组高于LP组(P<0.05)。术后ΔC_(2-7) CL组间差异无统计学意义(P>0.05),而末次差异有统计学意义(P<0.05)。LP组C_(2-7) SVA术后显著增加,LF组略增加,LP组略高于LF组,但差异无统计学意义(P>0.05);末次LP组显著降低,LF组显著增加,LP组结果低于LF组(P<0.05)。术后和末次ΔC_(2-7) SVA组间差异均有统计学意义(P<0.05)。两组T_(1)S术后均增加,而末次结果均减小,但组间差异均无统计学意义(P>0.05)。术后和末次ΔT_(1)S组间差异均有统计学意义(P<0.05)。两组末次随访JOAs和VAS与术前和末次随访的C_(2-7) CL,C_(2-7) SVA,T_(1)S,ΔC_(2-7) CL,ΔC_(2-7) SVA及ΔT_(1)S均无显著相关性(P>0.05)。两组不同时期的矢状面平衡比例差异均无统计学意义(P>0.05)。结论LP与LF治疗曲度不良性mCSM患者可获得相近的临床和影像学效果,但矢状面参数及其变化与临床疗效并无显著相关性。两种手术方式均�Objective To compare the clinical and radiographic outcomes for multilevel cervical spondylotic myelopathy(mCSM)preexisted with poor preoperative cervical curvature between laminoplasty(LP)and laminectomy with fusion(LF).Methods 73 mCSM patients associated with poor preoperative cervical curvature were retrospectively analyzed from Jan 2010 to Dec 2018.Patients were divided into LP group(n=41)and LF group(n=32)according to the surgical procedure.The sagittal alignment parameters including C_(2-7) cervical lordosis(C_(2-7) CL),C_(2-7) sagittal vertical axis(C_(2-7) SVA)and T_(1) slope(T_(1)S),and clinical outcome measures including Japanese orthopedic association scores(JOAs)and visual analogue scores(VAS)were analyzed.Results There was no statistically significant difference in general condition,preoperative sagittal parameters,JOAs,VAS,and follow-up time between the two groups of patients(P>0.05).The surgical segments in the LF group were fewer than those in the LP group,but the surgical time,bleeding volume,and complications were all higher in the LF group than in the LP group(P<0.05).Both groups of patients showed a significant increase in JOAs after surgery,with no significant changes observed in the last test.There was no statistically significant difference between the groups,and there was no statistically significant difference in the improvement rate and excellent rate of JOAs between the groups(P>0.05).Both groups showed a significant decrease in VAS after surgery,with the last significant decrease,and the LP group was lower than the LF group.Both groups showed a significant increase in C_(2-7) CL after surgery,with no statistically significant difference between the groups.The last LP group showed a significant decrease,while the LF group showed a mild decrease,with the LF group being higher than the LP group(P<0.05).There was no statistically significant difference in postoperativeΔC_(2-7) CL between the groups(P>0.05),while the final difference was statistically significant(P<0.05).The C_(2-7) SVA in

关 键 词：脊髓型颈椎病 单开门椎管成形术 椎板切除减压融合术 矢状面平衡 临床疗效 

分 类 号：R681.5[医药卫生—骨科学]