【摘要】 目的对比后路单开门椎管扩大椎板成形术并微型钛板内固定与双开门椎管扩大椎板成形术并LA椎板夹内固定治疗多节段脊髓型颈椎病(MCSM)的临床疗效。方法回顾性分析2015年4月—2017年9月山东中医药大学附属医院采用后路单开门椎管扩大椎板成形术并微型钛板内固定术(31例)和双开门椎管扩大椎板成形术并LA椎板夹内固定术(30例)治疗的MCSM患者临床资料。记录并比较2组手术时间、出血量、引流量和并发症发生情况,以及手术前后日本骨科学会(JOA)评分、颈椎Cobb角、C2～7矢状位平衡(SVA)。结果双开门组手术时间、出血量及引流量均低于单开门组,差异有统计学意义(P <0.05)。术后2组患者神经功能均显著改善,术后3个月及末次随访时2组JOA评分改善率差异无统计学意义(P> 0.05)。2组患者术后颈椎Cobb角及C2～7 SVA与术前相比,差异均无统计学意义(P> 0.05),组间比较差异也无统计学意义(P> 0.05)。单开门组发生轴性疼痛9例,后凸畸形8例,C5神经根麻痹1例,血管损伤1例。双开门组发生轴性疼痛5例,后凸畸形5例。结论 2种术式对改善MCSM患者神经功能均有较好的临床疗效,且安全性及可重复性好。双开门较单开门术式手术创伤小,远期疗效更佳,但手术难度较高;临床可结合患者病情及术者熟练程度选择最为适宜的手术方案。更多还原

【Abstract】 Objective To compare the clinical effects of posterior single-door laminoplasty combined with mini-titanium plate internal fixation and double-door laminoplasty combined with LA lamina staple internal fixation for the treatment of multilevel cervical spondylotic myelopathy（MCSM）. Methods The clinical data of 31 MCSM patients treated with posterior single-door laminoplasty combined with mini-titanium plate internal fixation and 30 MCSM patients treated with doubledoor laminoplasty combined with LA lamina staple internal fixation in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from April 2015 to September 2017 were retrospectively analyzed. The operation time,blood loss,drainage volume and complications were recorded and compared in the 2 groups,as well as the Japanese Orthopaedic Association（JOA） score,cervical Cobb’s angle,C2-7 sagittal vertical axis（SVA） before and after the operation. Results Operation time,blood loss and drainage volume were more significantly reduced in the double-door group than in the single-door group,all with statistical significances（P < 0.05）. Neurofunction was improved significantly after the operation in both groups,and there was no significant difference in the improvement rate of JOA score between the 2 groups at postoperative 3 months and the final follow-up（P > 0.05）. There was no significant difference in Cobb’s angle and C_2-7 SVA between pre-peration and post-operation of the 2 groups（P > 0.05）,and also no significant difference between the 2 groups（P > 0.05）. In the singledoor group,axial pain occurred in 9 cases,kyphosis in 8,C₅ nerve root paralysis in 1 and vascular injuryin 1. In the doubledoor group,axial pain occurred in 5 cases,kyphosis in 5. Conclusion The 2 surgical methods have good clinical efficacy in improving the neurological function of MCSM patients,with good safety and repeatability. Double-door operation has less trauma and better long-term effect than single-door operation,but it is more difficult to operate. Clinically,the most suitable surgical scheme can be selected according to the patient’s condition and the proficiency level of the operator.更多还原