改良的颈椎后路单开门椎管成形术的临床研究△

A clinical study on the cervical modified expansive open-door laminoplasty

摘要:

［目的］ 探讨改良的颈椎后路单开门椎管成形术 （expansive open-door laminoplasty, EODL） 的临床效果。［方法］ 2019 年 1 月—2021 年 6 月对 21 例颈椎管狭窄症、多节段颈椎病患者行改良的 EODL。评价临床与影像资料。［结果］21 例患者均顺利完成手术，术中均无脊髓、神经、椎动脉损伤、硬膜囊撕裂，无术后 C₅神经根麻痹。随访 12~36 个月，共 2 例患者术后出现新发的轴性痛，发生率为 9.52%；2 例轴性痛患者均为轻度，术后 3 个月随访时轴性痛消失。与术前相比，末次随访时 VAS、NDI 和 mJOA 评分均显著改善（P<0.05)。与术前相比，末次随访时影像测量颈椎前凸角显著丢失（P<0.05），但仍保持在较理想的水平。［结论］ 改良的 EODL 是一种安全的、有效的颈椎管扩大技术，可降低术后轴性痛、C5神经根麻痹等发生率，并且能够维持较好的颈椎曲度。

Abstract:

[Objective] To explore the clinical outcomes of posterior cervical modified expensive open- door laminoplasty (EODL) . [Methods] From January 2019 to June 2021, a total of 21 patients received improved EODL for multi-level cervical spinal stenosis or cervi- cal spondylosis. The clinical and radiographic documents were evaluated. [Results] All 21 patients had operation performed smoothly with no injuries to the spinal cord, nerve root and dural sac, and without C5 nerve root palsy. During the follow-up period lasted for 12~36 months, only 2 patients of them got new-onset axial pain after operation, accounting for 9.1%, which were mild, and disappeared at 3 months postop- eratively. The VAS, NDI and m JOA scores improved significantly at the latest follow-up compared with those preoperatively (P<0.05) . The physiological cervical lordotic curvature decreased significantly at the latest follow-up compared with that preoperatively (P<0.05) , whereas which remained in a reasonable range at the latest follow-up. [Conclusion] This modified EODL is a safe and effective technique to enlarge cervical spinal canal with advantages of reducing the incidence of postoperative axial pain and C₅ nerve root palsy and maintaining proper cervical curvature.