【摘要】 目的：探讨显微镜下颈后路经肌间隙入路单开门椎管扩大成形术的临床疗效。方法：选取2023年1月至2024年1月于北京大学第三医院行颈后路单开门椎管扩大成形术的216例患者作为研究对象，根据手术方式不同分为肌间隙入路组（106例）和传统入路组（110例）。两组患者均在术后1～5 d、3个月、6个月、9个月及1年进行门诊复查或电话随访。比较两组患者手术相关参数、颈部状态及颈部椎旁肌横截面积。结果：肌间隙入路组患者手术时间和住院时间均短于传统入路组，术中出血量少于传统入路组，差异均有统计学意义（P均<0.05）。两组患者术后并发症总发生率比较，差异无统计学意义（P>0.05）。术后即刻、术后1～5 d及术后3、6、9、12个月，肌间隙入路组患者疼痛VAS评分均低于传统入路组，差异均有统计学意义（P均<0.05）。术后3、6、9、12个月，肌间隙入路组患者颈部障碍指数（NDI）均低于传统入路组，差异均有统计学意义（P均<0.05）。术后12个月，肌间隙入路组患者颈部椎旁肌横截面积大于传统入路组，差异有统计学意义（P<0.05）。肌间隙入路组手术前后颈部椎旁肌横截面积差值小于传统入路组，差异有统计学意义（P<0.05）。结论：与传统后正中入路比较，显微镜下颈后路经肌间隙入路单开门椎管扩大成形术具有手术时间短、术中出血量少、住院时间短、术后疼痛轻的优势，且术后患者颈部功能恢复更好，临床效果满意。更多还原

【Abstract】 Objective: To investigate the clinical efficacy of microscope-assisted posterior cervical single open-door laminoplasty via the intramuscular approach. Methods: A total of 216 patients who underwent posterior cervical single open-door laminoplasty at the Department of Orthopaedics of Peking University Third Hospital from January 2023 to January 2024 was included. Patients were divided into the intramuscular approach group(n=106) and the traditional approach group(n=110) based on the surgical approach. Both groups were followed up through outpatient review or telephone at days 1 to 5, 3 months, 6 months, 9 months, and 1 year postoperatively. The surgery-related parameters, cervical status and cross-sectional area of cervical paravertebral muscles were compared between the two groups. Results: The intermuscular approach group had shorter surgical time and hospital stay, less intraoperative blood loss compared to the traditional approach group(all P<0.05). There was no significant difference in the overall incidence of postoperative complications between the two groups(P>0.05). The visual analog scale(VAS) pain scores of the intermuscular approach group were significantly lower than those of the traditional approach group at immediately and days 1 to 5, 3 months, 6 months, 9 months and 12 months postoperatively(all P<0.05). The neck disability index scores at 3, 6, 9, and 12 months postoperatively were significantly lower in the intermuscular approach group than that in the traditional approach group(all P<0.05). At 12 months postoperatively, the cross-sectional area of the paravertebral muscles in the intermuscular approach group was greater than that of the traditional approach group, which was statistically significant(P<0.05). The cross-sectional area of paravertebral muscles at 12 months after surgery was less compared to before surgery in this group, and the differences were statistically significant(all P<0.05).Conclusions: Compared with the traditional surgical approach, microscope-assisted posterior cervical single open-door laminoplasty via intramuscular approach has the advantages of shorter surgical time, less intraoperative blood loss, shorter hospital stay and milder postoperative pain, and leads to better recovery of cervical function and satisfactory clinical outcomes.更多还原