改良单开门椎板成形术治疗多节段脊髓型颈椎病

摘要

目的 评价改良单开门椎板成形术多节段脊髓型颈椎病的疗效.方法 2003年6月～2008年6月,采用改良单开门椎板成形术治疗多节段脊髓型颈椎病38例(A组),与同期传统单开门手术治疗的42例(B组)进行疗效分析比较,记录轴性症状、JOA评分及颈椎总活动度.结果 A组患者获随访13～54月,平均27.4月,B组患者获随访12～47月,平均25.7月.A组术前JOA评分(8.31±2.21)分,术后(14.00±1.90)分,改善率68.32%;B组术前JOA评分(8.00±2.41)分,术后(13.90±2.15)分,改善率67.63%,两组无明显差别.A组术后轴性症状发生率26.32%,B组术后轴性症状发生率50.00%,两组差异明显.A组颈椎总活动度为术前79.84%,B组颈椎总活动度为术前63.95%,两组差异明显.结论 改良单开门椎板成形术是一种安全有效的外科技术,能够有效减轻术后轴性症状,更大限度保留颈椎活动度.%Aim To investigate the clinical efficacy of modified open door laminoplasty in treating multi-segmental cervical spondylotic myelopathy. Methods From June 2003 to June 2008,38 cases with multi-segmental cervical spondylotic myelopathy were treated by modified open door laminoplasty ,and 42 cases were treated by traditional expansive open door laminoplasty . They were analyzed retrospectively using the Japanese Orthopetic Association (JOA) scale,Axial symptoms (AS) ,ranges of motion(ROM) of cervical vertebra.Results Patients of group A were followed up 13 to 54 months (average 27.4 month). Patients of group B were followed up 12 to 47 months (average 25.7 months). The average preoperative JOA score of group A was (8.31 ± 2.21) and postoperative JOA score was (14.00 ± 1.90) ,with an average improvement rate of 68.32％ . The average preoperative JOA score of group B was (8.00 ± 2.41) and postoperative JOA score was (13.90 ± 2.15) ,with an average improvement rate of 67.63％ (P ＞ 0.05). The incidence of postoperative AS of group A was 26.32％ ,and group B was 50.00％ (P ＜ 0.05). Postoperative ROM of group A was 79.84％ , and group B was 63.95％ (P ＜ 0.05). Conclusion Modified open door laminoplasty is a safe and effective surgical technique. It can reduce the incidence of postoperative AS effectively,and keep the ROM of cervical vertebra.