颈椎单开门椎管扩大成形术中重建伸肌附着点及保留C7棘突开槽式减压的临床疗效观察

观察颈椎单开门椎管扩大成形术中重建伸肌附着点及保留C7棘突开槽式减压在治疗脊髓性颈椎病的临床疗效。2017年01月～2018年07月有81例多节段脊髓型颈椎病患者在我院接受单开门椎管扩大成形术治疗,其中70例获得完整临床随访。根据手术方法将其分为两组：观察组(37例),单开门术中采用伸肌附着点重建和保留C7棘突开槽式减压治疗；对照组(33例),行常规单开门椎管成形钛板固定术治疗。记录手术时间及术中出血量,观察术后患者神经功能改善、颈椎曲度指数(cervical curvature index,CCI)改变、颈后肌群横截面积变化及轴性症状(axial symptoms,AS)的发生情况。结果表明：观察组在手术时间及术中出血量上明显高于对照组(P<0.05)；在椎板开门角度及脊髓漂移距离上,两组比较无显著统计学差异(P>0.05)；术后两组患者的JOA评分较术前有显著升高(P<0.05),两组在神经功能恢复率上无显著统计学差异(P>0.05)。观察组在CCI及颈后肌群横截面积上与术前比较无显著统计学差异(P>0.05),对照组的上述数值较术前明显减小(P<0.05)。观察组轴性症状发生率为8.1%(3/37),对照组为21.2%(7/33),具有显著统计学差异(P<0.05)。可见,在单开门椎管成形术中,重建伸肌附着点及保留C7棘突开槽式减压会增加手术时间,但术式的改进可以更好的维持颈椎曲度,减轻颈后肌群萎缩并降低术后轴性症状的发生。

The clinical effect of muscle attachment point reconstruction and C7 slotted decompression with preservation of spinous process in laminoplastyJIANG Zhong-chao, HAN Xiao-hui, YUAN Yu-fei, TIAN Jin-hui, LI Xiao-dong, MIAO Jie

The research was aimed to investigate the clinical effects of muscle attachment point reconstruction and C7 lamina slotted decompression with preservation of spinous process in laminoplasty for the treatment of cervical spondylotic myelopathy (CSM). From January 2017 to July 2018, 81 patients with multi-segment CSM underwent open-door laminoplasty in our hospital, and 70 of them received complete clinical follow-up. Patients were divided into two groups according to the surgical method. The observation group (37 cases) accepted muscle attachment point reconstruction and C7 slotted decompression with preservation of spinous process, and the control group (33 cases) accepted conventional open-door laminoplasty. The operative time and introperative blood loss were recorded, and the improvement of neurological function (JOA score), cervical curvature index (CCI), cross-sectional area of the posterior cervical muscles, and the occurrence of axial symptoms (AS) were observed and compared. The observation group was significantly higher than the control group in the operative time and introperative blood loss (P <0.05). There was no significant difference in the lamina opening angle and spinal cord drift distance (P> 0.05). The postoperative JOA score increased significantly in both groups when compared with the preoperative level (P <0.05), and there was no significant difference in the neurological recovery rate (P> 0.05). In observation group, the CCI and the cross-sectional area of the posterior muscles were sustained well when compared with those before surgery (P> 0.05), while the control group had a significant decrease (P <0.05). The incidence of axial symptoms was 8.1% (3/37) in observation group and 21.2% (7/33) in the control group (P <0.05). In open door laminoplasty, the procedure of muscle attachment point reconstruction and C7 lamina slotted decompression with preservation spinous process will increase the operative time, but this technical improvement could maintain the cervical curvature, reduce the atrophy of cervical muscles and decrease the occurrence of axial symptoms.