C3椎板切除的頸椎單開門椎管擴大成形術治療多節段脊髓型頸椎病的療效分析

郭中帥 陳長青 林東 王升 林棟 崔新華 趙澤

【摘要】?目的?探討C3椎板切除的頸椎單開門椎管擴大成形術治療多節段脊髓型頸椎病的臨床療效。方法?分析2010年4月至2017年10月74例行單開門椎管擴大成形術治療多節段脊髓型頸椎病患者的臨床資料，將其中接受 C3椎板切除單開門椎管擴大成形術的32例患者作為改良組，將接受傳統單開門椎管擴大成形術的42例患者作為對照組。記錄兩組患者手術時間、術中出血量及比較術前和術后6個月隨訪JOA評分、頸椎活動范圍（ROM）、頸椎曲度指數（CCI）、軸性癥狀（AS）嚴重程度。結果?兩組手術時間、術中出血量及術后出血量比較差異均無統計學意義（P>0.05）。兩組術前JOA評分、術后6個月評分以及改善率比較差異均無統計學意義（P>0.05）。改良組術后AS評級優于對照組，比較差異有統計學意義（P<0.05）。兩組患者術前、術后的ROM值及ROM丟失值比較差異均有統計學意義（P<0.01），改良組術后的ROM值低于對照組，ROM丟失值少于對照組。兩組患者CCI丟失值比較差異有統計學意義（P<0.01），改良組的CCI丟失值少于對照組。結論?C3椎板切除的改良單開門椎管擴大成形術在獲得與傳統手術同樣神經改善率的同時，可以明顯降低頸椎軸性癥狀的發生，有利于頸椎活動度及曲度的維持。

【關鍵詞】?椎板切除;單開門椎管擴大成形術;軸性癥狀;脊髓型頸椎病

中圖分類號：R687.3?文獻標志碼：A?DOI：10.3969/j.issn.1003-1383.2019.03.008

【Abstract】?Objective?To explore the clinical effects of modified open-door laminoplasty with C3 laminectomy for multiple-segment cervical splndylotic myelopathy.Methods?From April 2010 to October 2017，clinical data of 74 patients who underwent modified open-door laminoplasty for multiple-segment cervical splndylotic myelopathy were analyzed.32 patients who received modified open-door laminoplasty with C3 laminectomy were selected as modified group，and 42 patients who received traditional open-door laminoplasty as control group.And then，operation time and intraoperative bleeding volume were recorded，and JOA scores，cervical range of motion（ROM），cervical curvature index（CCI） and severity of axial symptoms（AS） were compared before operation and 6 months of follow-up after operation in the two groups.Results?There was no statistically significant difference in operative time，intraoperative bleeding volume and postoperative bleeding volume between the two groups（P>0.05）.Difference of JOA scores before operation，the scores 6 months after operation and improvement rates in the two group was not statistically significant（P>0.05）.The AS rating of the modified group was better than that of the control group，difference was statistically significant（P<0.05）.There was statistically significant difference in ROM value and ROM missing value between the two groups before and after operation（P<0.01），and the ROM value and ROM missing value in the modified group were lower than those in the control group.In addition，the difference of CCI missing value between the two groups was ?statistically significant（P<0.01），and the CCI missing value in the modified group was lower than that in the control group.Conclusion?Modified open-door laminoplasty with C3 laminectomy significantly reduce the occurrence of cervical axial symptoms while obtaining the same rate of nerve improvement as traditional surgery，which is conducive to the maintenance of cervical motion and curvature.