C3椎板切除的颈椎单开门椎管扩大成形术治疗多节段脊髓型颈椎病的疗效分析

郭中帅 陈长青 林东 王升 林栋 崔新华 赵泽

【摘要】 目的 探討C3椎板切除的颈椎单开门椎管扩大成形术治疗多节段脊髓型颈椎病的临床疗效。方法 分析2010年4月至2017年10月74例行单开门椎管扩大成形术治疗多节段脊髓型颈椎病患者的临床资料，将其中接受 C3椎板切除单开门椎管扩大成形术的32例患者作为改良组，将接受传统单开门椎管扩大成形术的42例患者作为对照组。记录两组患者手术时间、术中出血量及比较术前和术后6个月随访JOA评分、颈椎活动范围（ROM）、颈椎曲度指数（CCI）、轴性症状（AS）严重程度。结果 两组手术时间、术中出血量及术后出血量比较差异均无统计学意义（P>0.05）。两组术前JOA评分、术后6个月评分以及改善率比较差异均无统计学意义（P>0.05）。改良组术后AS评级优于对照组，比较差异有统计学意义（P<0.05）。两组患者术前、术后的ROM值及ROM丢失值比较差异均有统计学意义（P<0.01），改良组术后的ROM值低于对照组，ROM丢失值少于对照组。两组患者CCI丢失值比较差异有统计学意义（P<0.01），改良组的CCI丢失值少于对照组。结论 C3椎板切除的改良单开门椎管扩大成形术在获得与传统手术同样神经改善率的同时，可以明显降低颈椎轴性症状的发生，有利于颈椎活动度及曲度的维持。

【关键词】 椎板切除;单开门椎管扩大成形术;轴性症状;脊髓型颈椎病

中图分类号：R687.3 文献标志码：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.