[1]黄 帅,尤 涛.单开门减压与全椎板切除治疗脊髓型颈椎病的临床疗效[J].医学信息,2023,36(07):96-100.[doi:10.3969/j.issn.1006-1959.2023.07.017]
　HUANG Shuai,YOU Tao.Clinical Effect of Single-door Decompression and Total Laminectomy in the Treatment of Cervical Spondylotic Myelopathy[J].Journal of Medical Information,2023,36(07):96-100.[doi:10.3969/j.issn.1006-1959.2023.07.017]
点击复制

单开门减压与全椎板切除治疗脊髓型颈椎病的临床疗效()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年07期
页码:
96-100
栏目:
论著
出版日期:
2023-04-01

文章信息/Info

Title:
Clinical Effect of Single-door Decompression and Total Laminectomy in the Treatment of Cervical Spondylotic Myelopathy
文章编号:
1006-1959（2023）07-0096-05
作者:
黄 帅; 尤 涛
（安徽医科大学附属安徽省立医院脊柱外科，安徽 合肥 230001）
Author(s):
HUANG Shuai; YOU Tao
(Department of Spinal Surgery,Anhui Provincial Hospital Affiliated to Anhui Medical University,Hefei 230001,Anhui,China)
关键词:
脊髓型颈椎病; 单开门椎管减压; 全椎板切除; C5神经根麻痹
Keywords:
Cervical spondylotic myelopathy; Single-door decompression; Total laminectomy; C5 nerve root palsy
分类号:
R681.5
DOI:
10.3969/j.issn.1006-1959.2023.07.017
文献标志码:
A
摘要:
目的 比较颈后路单开门椎管减压术与全椎板切除减压侧块螺钉内固定术治疗多节段脊髓型颈椎病的临床疗效。方法 回顾性分析2016年5月-2020年6月我院收治的131例脊髓型颈椎病患者临床资料，根据手术方式分为观察组（65例）和对照组（66例）。对照组行全椎板切除侧块螺钉内固定术，观察组行颈后路单开门椎管减压术，比较两组手术时间、病程、住院时间、颈椎Cobb角、颈椎活动度、JOA评分及术后轴性疼痛、C5神经根麻痹情况。结果 两组病程、住院时间比较，差异无统计学意义（P＞0.05）；观察组手术时间短于对照组（P＜0.05）；两组颈椎Cobb角、颈椎ROM均较术前下降，观察组颈椎ROM高于对照组，ROM丢失率低于对照组（P＜0.05）；观察组颈椎曲度低于对照组，曲度下降率高于对照组（P＜0.05）；两组JOA评分均较术前提高，但两组间比较，差异无统计学意义（P＞0.05）；观察组术后轴性疼痛发生率低于对照组（P＜0.05）；两组C5神经根麻痹发生率比较，差异无统计学意义（P＞0.05）。结论 单开门和全椎板手术均能有效缓解脊髓压迫症状，但单开门手术具有手术时间短、颈椎活动度破坏小、术后轴性疼痛发生率低等优点；而全椎板手术较好维持了颈椎曲度，能避免术后再狭窄的发生。
Abstract:
Objective To compare the clinical efficacy of posterior cervical single-door decompression and total laminectomy decompression and lateral mass screw fixation in the treatment of multi-segmental cervical spondylotic myelopathy.Methods The clinical data of 131 patients with cervical spondylotic myelopathy admitted to our hospital from May 2016 to June 2020 were retrospectively analyzed. According to the surgical methods, they were divided into observation group (65 cases) and control group (66 cases). The control group was treated with total laminectomy and lateral mass screw internal fixation, and the observation group was treated with posterior cervical single open-door spinal canal decompression. The operation time, course of disease, hospitalization time, cervical Cobb angle, cervical mobility, JOA score, postoperative axial pain and C5 nerve root paralysis were compared between the two groups.Results There was no significant difference in the course of disease and hospitalization time between the two groups (P>0.05). The operation time of the observation group was shorter than that of the control group (P<0.05). The cervical Cobb angle and cervical ROM of the two groups were lower than those before operation. The cervical ROM of the observation group was higher than that of the control group, and the ROM loss rate was lower than that of the control group (P<0.05). The cervical curvature of the observation group was lower than that of the control group, and the decrease rate of curvature was higher than that of the control group (P<0.05). The JOA scores of the two groups were higher than those before operation, but there was no significant difference between the two groups (P>0.05). The incidence of postoperative axial pain in the observation group was lower than that in the control group (P<0.05). There was no significant difference in the incidence of C5 nerve root palsy between the two groups (P>0.05).Conclusion Both single-door and total laminectomy can effectively relieve the symptoms of spinal cord compression, but single-door surgery has the advantages of short operation time, small damage to cervical mobility, and low incidence of postoperative axial pain. While the total laminectomy can better maintain the cervical curvature, and avoid the occurrence of postoperative restenosis.

参考文献/References:

[1]唐冰,张琼,熊敏.两种后路内固定结合单开门手术治疗多节段脊髓型颈椎病的近期疗效比较[J].临床合理用药杂志,2019,12(19):152-153.[2]关晓明,马迅.脊髓型颈椎病手术入路及减压融合方式的选择策略[J].中华骨科杂志,2019,39(23):1478-1484.[3]蒋俊锋,蒋建刚,蒋建农.颈前路多节段单间隙固定和椎体次全切钛网固定治疗多节段脊髓型颈椎病临床疗效对比[J].中国临床医生杂志,2017,45(8):65-67.[4]Liu X,Wang H,Zhou Z,et al.Anterior decompression and fusion versus posterior laminoplasty for multilevel cervical compressive myelopathy[J].Orthopedics,2014,37(2):e117-e122.[5]彭鸿辉,王德加.后路单开门钛板内固定椎管扩大成形术治疗颈椎后纵韧带骨化症的临床效果观察[J].罕少疾病杂志,2021,28(3):98-100.[6]Kopjar B,Bohm PE,Arnold JH,et al.Outcomes of Surgical Decompression in Patients With Very Severe Degenerative Cervical Myelopathy[J].Spine,2018,43(16):1102-1109. [7]王义生.多节段或“钳夹型”脊髓型颈椎病手术入路的选择[J].中国脊柱脊髓杂志,2010,20(3):185-186.[8]饶敏杰,严宁,侯铁胜,等.颈前路手术治疗4个节段脊髓型颈椎病的中期疗效分析[J].中国脊柱脊髓杂志,2020,30(4):346-352.[9]Hatta Y,Shiraishi T,Hase H,et al.Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy?[J].Spine,2005,30(21):2414-2419.[10]井龙飞,罗绪建,丛琳,等.前路与后路手术治疗多节段脊髓型颈椎病的比较[J].中国矫形外科杂志,2018,26(11):972-976.[11]Bajamal AH,Kim SH,Arifianto MR,et al.Posterior Surgical Techniques for Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations[J].Neurospine,2019,16(3):421-434. [12]Sakaura H,Hosono N,Mukai Y,et al.Preservation of the nuchal ligament plays an important role in preventing unfavorable radiologic changes after laminoplasty[J].Journal of Spinal Disorders & Techniquesvol,2008,21(5):338-343. [13]Highsmith JM,Dhall SS,Haid RW,et al.Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion[J].Journal of Neurosurgery Spine,2011,14(5):619-625.[14]Yang L,Gu Y,Shi J,et al.Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy[J].Orthopedics,2013,36(1):e79-e87.[15]Duan Y,Zhang H,Min SX,et al.Posterior cervical fixation following laminectomy: a stress analysis of three techniques[J].Eur Spine J,2011,20(9):1552-1559.[16]范钦玮,朱忠培,邵佳,等.两种术式治疗长节段颈椎后纵韧带骨化症的疗效分析[J].医药论坛杂志,2022,43(8):5-10.[17]Iizuka H,Iizuka Y,Nakagawa Y,et al.Interlaminar bony fusion after cervical laminoplasty: its characteristics and relationship with clinical results[J].Spine,2006,31(6):644-647.[18]薛营杰,赵斌,路坦,等.颈后路单开门椎管成形术和全椎板减压术治疗多节段颈椎后纵韧带骨化症效果比较[J].新乡医学院学报,2019,36(7):649-653.[19]江丽强,岳亚玲,颜继英,等.不同固定方法对颈椎单开门术后颈椎曲度和活动度的影响[J].现代中西医结合杂志,2015,24(22):2445-2447.[20]熊英杰,王玉强,师蓝达,等.保留C3、C7的改良椎管扩大成形术治疗颈椎病的效果及对颈椎活动度和曲度的影响[J].河南医学研究,2021,30(11):1934-1938.[21]Sasai K,Saito T,Akagi S,et al.Cervical curvature after laminoplasty for spondylotic myelopathy--involvement of yellow ligament, semispinalis cervicis muscle, and nuchal ligament [J].J Spinal Disord,2000,13(1):26-30.[22]赵翊博,徐文潇,奚春阳,等.后路颈椎术后重建肌肉骨性止点对颈半棘肌形态及功能的影响[J].脊柱外科杂志,2021,19(4):265-269.[23]张为,陈百成,申勇,等.颈3椎板切除单开门成形术对颈椎轴性症状的影响[J].中华骨科杂志,2006,26(8):544-548.[24]许海宁,李亮,于学忠,等.两种颈后路术式治疗多节段脊髓型颈椎病术后C5神经根麻痹分析[J].颈腰痛杂志,2015,36(4):293-297.

相似文献/References:

[1]黄家琦,刘晓奇,李华帅.脊髓型颈椎病及后纵韧带骨化的遗传学研究现状[J].医学信息,2020,33(03):49.[doi:10.3969/j.issn.1006-1959.2020.03.015]
　HUANG Jia-qi,LIU Xiao-qi,LI Hua-shuai.Genetic Study of Cervical Spondylotic Myelopathy and Ossification of Posterior Longitudinal Ligament[J].Journal of Medical Information,2020,33(07):49.[doi:10.3969/j.issn.1006-1959.2020.03.015]
[2]许世林,白贵文,薛东鹤,等.颈前路零切迹椎间融合器治疗邻近双节段脊髓型颈椎病的疗效分析[J].医学信息,2023,36(16):98.[doi:10.3969/j.issn.1006-1959.2023.16.018]
　XU Shi-lin,BAI Gui-wen,XUE Dong-he,et al.Clinical Analysis of Anterior Cervical Interbody Fusion with Zero-P in the Treatment of Adjacent Two-level Cervical Spondylotic Myelopathy[J].Journal of Medical Information,2023,36(07):98.[doi:10.3969/j.issn.1006-1959.2023.16.018]

更新日期/Last Update: 1900-01-01