C3椎板切除的頸椎單開門椎管擴(kuò)大成形術(shù)治療多節(jié)段脊髓型頸椎病的療效分析

郭中帥 陳長(zhǎng)青 林東 王升 林棟 崔新華 趙澤

【摘要】?目的?探討C3椎板切除的頸椎單開門椎管擴(kuò)大成形術(shù)治療多節(jié)段脊髓型頸椎病的臨床療效。方法?分析2010年4月至2017年10月74例行單開門椎管擴(kuò)大成形術(shù)治療多節(jié)段脊髓型頸椎病患者的臨床資料，將其中接受 C3椎板切除單開門椎管擴(kuò)大成形術(shù)的32例患者作為改良組，將接受傳統(tǒng)單開門椎管擴(kuò)大成形術(shù)的42例患者作為對(duì)照組。記錄兩組患者手術(shù)時(shí)間、術(shù)中出血量及比較術(shù)前和術(shù)后6個(gè)月隨訪JOA評(píng)分、頸椎活動(dòng)范圍（ROM）、頸椎曲度指數(shù)（CCI）、軸性癥狀（AS）嚴(yán)重程度。結(jié)果?兩組手術(shù)時(shí)間、術(shù)中出血量及術(shù)后出血量比較差異均無統(tǒng)計(jì)學(xué)意義（P>0.05）。兩組術(shù)前JOA評(píng)分、術(shù)后6個(gè)月評(píng)分以及改善率比較差異均無統(tǒng)計(jì)學(xué)意義（P>0.05）。改良組術(shù)后AS評(píng)級(jí)優(yōu)于對(duì)照組，比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組患者術(shù)前、術(shù)后的ROM值及ROM丟失值比較差異均有統(tǒng)計(jì)學(xué)意義（P<0.01），改良組術(shù)后的ROM值低于對(duì)照組，ROM丟失值少于對(duì)照組。兩組患者CCI丟失值比較差異有統(tǒng)計(jì)學(xué)意義（P<0.01），改良組的CCI丟失值少于對(duì)照組。結(jié)論?C3椎板切除的改良單開門椎管擴(kuò)大成形術(shù)在獲得與傳統(tǒng)手術(shù)同樣神經(jīng)改善率的同時(shí)，可以明顯降低頸椎軸性癥狀的發(fā)生，有利于頸椎活動(dòng)度及曲度的維持。

【關(guān)鍵詞】?椎板切除;單開門椎管擴(kuò)大成形術(shù);軸性癥狀;脊髓型頸椎病

中圖分類號(hào)：R687.3?文獻(xiàn)標(biāo)志碼：A?DOI：10.3969/j.issn.1003-1383.2019.03.008

【Abstract】?Objective?To explore the clinical effects of modified open-door laminoplasty with C3 laminectomy for multiple-segment cervical splndylotic myelopathy.Methods?From April 2010 to October 2017，clinical data of 74 patients who underwent modified open-door laminoplasty for multiple-segment cervical splndylotic myelopathy were analyzed.32 patients who received modified open-door laminoplasty with C3 laminectomy were selected as modified group，and 42 patients who received traditional open-door laminoplasty as control group.And then，operation time and intraoperative bleeding volume were recorded，and JOA scores，cervical range of motion（ROM），cervical curvature index（CCI） and severity of axial symptoms（AS） were compared before operation and 6 months of follow-up after operation in the two groups.Results?There was no statistically significant difference in operative time，intraoperative bleeding volume and postoperative bleeding volume between the two groups（P>0.05）.Difference of JOA scores before operation，the scores 6 months after operation and improvement rates in the two group was not statistically significant（P>0.05）.The AS rating of the modified group was better than that of the control group，difference was statistically significant（P<0.05）.There was statistically significant difference in ROM value and ROM missing value between the two groups before and after operation（P<0.01），and the ROM value and ROM missing value in the modified group were lower than those in the control group.In addition，the difference of CCI missing value between the two groups was ?statistically significant（P<0.01），and the CCI missing value in the modified group was lower than that in the control group.Conclusion?Modified open-door laminoplasty with C3 laminectomy significantly reduce the occurrence of cervical axial symptoms while obtaining the same rate of nerve improvement as traditional surgery，which is conducive to the maintenance of cervical motion and curvature.