【摘要】 目的提出移动K线征(+)的理念;探讨针对K线征(-)的多节段脊髓型颈椎病患者,运用移动K线征指导选择性椎板成形术的可行性。方法定义移动K线征(+):术前磁共振成像(magnetic resonance imaging, MRI)片上K线征(-)时,通过向上或向下移动和(/或)延长K线(例如C3-T1椎管中点的连线),致该线与前方致压物未有接触,称为移动K线征(+)。回顾性分析2013年6月～2018年10月我科收治的21例多节段脊髓型颈椎病患者,其K线征(-)而经评估移动K线征(+),行颈椎后路非C3-C7单开门椎板成形术。根据术前与术后MRI比较脊髓向后漂移情况、计算机断层摄影(computed tomography, CT)矢状位椎管前后径变化、日本骨科协会(Japanese Orthopaedic Association, JOA)评分和颈椎功能障碍指数(neck disabilitv index, NDI),评价脊髓减压效果和临床疗效;记录C5神经根麻痹、脑脊液漏和轴性疼痛发生率。结果术前与术后MRI比较结果显示脊髓明显向后漂移,脊髓受压均得到解除;术后椎管前后径较术前明显增加,差异有统计学意义(P<0.05)。21例病例均获得至少12个月的随访。术后1周、1年和末次随访的JOA评分和NDI评分较术前明显提高(P<0.05)。其中1例患者术后脊髓明显向后漂移,脊髓受压解除,但临床疗效欠佳,术后JOA评分和NDI评分较术前未有明显改善。出现C5神经根麻痹2例(9.50%),轴性疼痛3例(14.3%),术后脑脊液漏1例(4.8%)。结论对K线征(-)的多节段脊髓型颈椎病患者,通过移动K线,使移动K线征(+),以此重新确定开门节段和范围,可以使K线征(-)的多节段脊髓型颈椎病患者仅行颈椎后路单开门椎板成形术也同样获得良好脊髓减压效果和满意临床疗效,从而避免行前路多节段、椎体次全切手术或前后联合手术。更多还原

【Abstract】 Objective To propose the theory of mobile K-line positive. For patients with multilevel cervical spondylosis myelopathy(MCSM) with K-line(-), the K-line was moved to re-determine the open segment and scope of single-door laminoplasty, so that some patients of K-line(-) may only accept cervical single-door laminoplasty with satisfactory clinical results. Methods Defining the concept of mobile K-line(+): for the pre-operative K-line(-) on MRI films, the K-line(the line connecting the midpoint of C3-T1 spinal canal) was moved up or down or extending, so as to have no contact with the space-occupying lesions. A retrospective analysis of 21 patients was carried out with MCSM evaluated by mobile K-line(+) from June 2013 to October 2018 in our department, in whom selective laminoplasty was operated. Spinal cord backward drifts were compared between preoperative and postoperative MRI. Changes of anteroposterior diameter of spinal canal in sagittal position were compared between preoperative and postoperative CT.And the preoperative and postoperative JOA scores and NDI scores were recorded to evaluate spinal decompression and clinical efficacy.The incidence of C5 nerve root paralysis,cerebrospinal fluid leakage,and axial pain was followed up as well.Results The comparison of preoperative and postoperative MRI results showed that the spinal cord drifted significantly backward and the spinal cord compression got relieved,and the anterior and posterior diameter of the spinal canal increased significantly compared with the pre-operative one,and the differences were statistically significant(P<0.05).All 21 cases were followed up for at least 12 months.The 1-week,1-year and the last follow-up of JOA score and NDI of 20 patients were significantly higher than the pre-operative one (P<0.05).The spinal cord of one patient was significantly drifted backward after surgery,and compression was relieved,but the clinical effect was not good,so his postoperative JOA score and NDI had no significantly improvement.There was C5nerve root palsy occurred in 2 cases (9.50%),axial pain in 3 cases (14.3%),and postoperative cerebrospinal fluid leakage in 1 patient (4.8%).Conclusion For MCSM patients with K-line(-),it can re-determine the open segment and scope by moving the K-line to make the mobile K-line (+).So this type of patients may have a chance to undergo selective laminoplasty to achieve good decompression and satisfactory clinical results.更多还原