多节段脊髓型颈椎病两种椎管扩大成形术比较

Comparison of two types of expanded laminoplasty for multilevel cervical spondylotic myelopathy

摘要:

[目的] 比较两种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] 回顾性分析本院 2018 年 3 月— 2021 年 9 月治疗的多节段脊髓型颈椎病 65 例患者的临床资料。其中，32 例行 C_4~6单开门椎管扩大成形术（改良组），33 例行常规 C_3~7单开门椎管扩大成形术（常规组）。比较围手术期、随访及影像结果。[结果]两组患者均顺利完成手术，术中均未出现脊髓神经损伤、脑脊液漏。改良组手术时间、术中出血量、切口长度和术后引流量均显著优于常规组 （P＜0.05）。所有患者随访时间平均（11.3±1.8）个月，两组恢复完全负重活动时间的差异无统计学意义（P＞0.05）。随时间推移，两组 VAS、NDI 评分显著减少（P＜0.05），JOA 评分显著增加（P＜0.05），术后 3、6、12 个月改良组上述指标均显著优于常规组（P＜0.05）。影像方面，与术前相比，两组患者术后 3、6、12 个月 C_2~7Cobb 角显著减小 （P＜0.05），而 C_2~7 SVA 显著增加 （P＜0.05）。术前及术后 3 个月，两组 C_2~7 Cobb 角、C_2~7 SVA 的差异均无统计学意义 （P＞0.05），术后 6、12 个月改良组 C_2~7 SVA 显著小于常规组 （P＜0.05），C_2~7Cobb 角显著大于常规组（P＜0.05），末次随访时两组均未出现内置物钛板松动导致的椎板关闭，以及进行性后凸畸形等不良影像表现。[结论] 两组术后均取得良好的临床疗效，但改良组较好地保留了颈椎矢状位平衡，且改良组出血少， 创伤范围小，是治疗多节段脊髓型颈椎病的有效选择方案。

Abstract:

[Objective] To compare the clinical outcomes of two types of expanded laminoplasty in the treatment of multilevel cervical spondylotic myelopathy. [Methods] A retrospective study was conducted on 65 patients who received surgical treatment for multisegmented cervical spondylotic myelopathy in our hospital from March 2018 to September 2021. Among them, 32 patients underwent the modified C_4~6 unilateral open- door laminoplasty (the modified group), while the remaining 33 patients received conventional C_3~7 unilateral open- door laminoplasty (the conventional group). The perioperative period, follow- up and imaging consequences were compared between the two groups. [Results] All patients in both groups had the corresponding laminoplasties performed successfully with no spinal nerve injury or ce- rebrospinal fluid leakage. The modified group proved significantly superior to the conventional group in term of operation time, intraopera- tive blood loss, incision length and postoperative drainage volume (P＜0.05). All patients in both groups were followed up for (11.3±1.8) months on average, without significant difference in the time to return to full weight-bearing activity between the two groups (P＞0.05). The VAS and NDI scores significantly decreased (P＜0.05), while the JOA score significantly increased over time in both groups (P＜0.05), which in the modified group were significantly superior to those in the conventional group at 3, 6, and 12 months after operation (P＜0.05). In terms of imaging, the C_2~7 Cobb significantly decreased, while C_2~7 SVA was significantly increased at 3, 6, and 12 months after operation com- pared with those preoperatively (P＜0.05). Nevertheless, there were no significant differences in C_2~7 Cobb and C_2~7 SVA between the two groups before operation and 3 months after operation (P＞0.05), the modified group was significantly superior to the conventional groups in abovementioned imaging parameters at 6 and 12 months after operation (P＜0.05). At the last follow-up, no laminar reclosure caused by tita- nium plate loosening, progressive kyphosis and other adverse imaging manifestations were noted in anyone of the two groups. [Conclusion] Both groups achieve good clinical efficacy after operation, by comparison, the modified laminoplasty has advantages of less bleeding and less iatrogenic trauma and better preservation of the cervical sagittal balance over the conventional procedure, which might be considered as better choice for the treatment of multilevel cervical spondylotic myelopathy.