【摘要】 目的观察评价重建后方韧带复合体的颈椎单开门桥式植骨椎板成形术,在降低术后轴性症状发生和减少颈椎曲度丢失中的作用。方法2000年6月～2005年10月,对138例脊髓型颈椎病患者行重建后方韧带复合体的颈椎单开门桥式植骨椎板成形术。选取其中2003年10月前78例行此手术且随访资料完整患者(改良单开门,A组),与同期69例行常规单开门手术的患者(传统单开门,B组)进行对比分析。记录手术时间、术中出血量、轴性症状及JOA评分,根据X线片计算颈椎总活动度(rangesofmotion,ROM)和颈椎曲度指数。结果A组患者均获随访24～44个月,平均33个月。B组患者均获随访24～53个月,平均35个月。手术时间:A组114±20min,B组70±25min,差异有统计学意义(P<0.05);术中出血量:A组280±72ml,B组210±80ml(P>0.05);JOA评分:A组恢复率为67.0%±17.3%,B组为65.0%±21.4%(P>0.05);A组9例(12%)、B组35例(51%)术后发生轴性症状或加重,组间比较差异有统计学意义(P<0.05)。A组术后ROM为术前的88.0%±10.1%,B组为术前的64.0%±16.3%(P<0.05);A组曲度指数术前15.3±8.2,术后13.5±9.3,差异无统计学意义(P>0.05);B组术前17.2±13.5,术后11.1±5.7,差异有统计学意义(P<0.05)。结论重建后方韧带复合体的颈椎单开门桥式植骨椎板成形术,可最大限度保留并重建颈椎后方结构,有利于早期功能锻炼,减少轴性症状的发生和颈椎曲度的丢失,提高了后路手术对颈椎病的治疗效果。更多还原

【Abstract】 Objective To explore if the modified unilaterally-open expansive laminoplasty using bridge grafting and reconstructing posterior ligamentous complex methods is effective in preventing persisting axial symptoms,restriction of neck motion,and loss of cervical curvature.Methods From June 2000 to October 2005,138 patients with cervical spondylotic myelopathy underwent this procedure.Of them,78 who were followed for more than 2 years(group A)were included in this study.Another 69 patients who underwent conventional unilaterally open-door laminoplasty served as controls(group B).The JOA scores and the incidence of newly developed or deteriorated axial symptoms were recorded.Preoperative and postoperative ranges of neck motion were measured on lateral flexion and extension radiographs.Preoperative and postoperative cervical curvature indices were calculated according to Ishihara’s method.Results The patients of group A were followed 24-44 months(mean 33 months),and the patients of group B were followed 24-53 months(mean 35 months).The operative time was 114±20 min in group A and 70±25 min in group B,showing statistically significant difference(P<0.05).The operative blood loss was 280±72 ml in group A and 210±80 ml in group B(P>0.05).According to JOA scoring,the average recovery rates were 67.0%±17.3% in group A and 65.0%±21.4% in group B(P>0.05).Postoperative development or deterioration of axial symptoms occurred in 12% of patients in group A and 51% of patients in group B,showing statistically significant difference(P<0.05).Postoperative range of neck motion was 88.0%±10.1% of the preoperative one in group A and 64.0%±16.3% in group B(P<0.05).There was no significant difference between preoperative(15.3±8.2)and postoperative(13.5±9.3)cervical curvature index in group A,whereas the mean value of postoperative index(11.1±5.7)was significantly smaller than that of preoperative one(17.2±13.5)in group B(P<0.05).Conclusion This new procedure was less invasive to the posterior extensor mechanism than the conventional unilaterally-open laminoplasty and was effective in preventing postoperative morbidities.更多还原