颈椎后路单开门椎管扩大椎板成形术中C2处理策略：“穹顶”减压与椎板开门

关键词：颈椎  骨化，后纵韧带  减压术，外科

Keywords:Cervical vertebrae  Ossification,posterior longitudinal ligament  Decompression,surgical

摘要：

      目的 比较在颈椎后路单开门椎管扩大椎板成形术中不同C₂处理策略（“穹顶”减压与椎板开门）治疗上颈椎后纵韧带骨化症（OPLL）的疗效及预后。方法 2022年1月—2024年6月，采用颈椎后路单开门椎管扩大椎板成形术治疗上颈椎OPLL患者71例，其中39例术中C₂行“穹顶”减压（穹顶组），32例C₂行椎板开门（开门组）。记录患者手术前后日本骨科学会（JOA）评分、视觉模拟量表（VAS）评分、颈椎功能障碍指数（NDI）、影像学指标[椎管最大占位率（MCSR）、脊髓后方漂移（CPS）、颈椎活动度（ROM）]及术后并发症情况。结果 所有手术顺利完成，所有患者随访时间> 12个月。2组术后12个月JOA评分、VAS评分、NDI较术前显著改善，差异均有统计学意义（P < 0.05）。术后12个月，穹顶组VAS评分优于开门组，差异有统计学意义（P < 0.05）；2组JOA评分、NDI差异无统计学意义（P > 0.05）。2组术后12个月MCSR、CPS较术前改善，ROM较术前下降，差异均有统计学意义（P < 0.05）。术后12个月，开门组MCSR、CPS优于穹顶组，ROM损失也重于穹顶组，差异均有统计学意义（P < 0.05）。2组均未发生C₅神经根麻痹、再关门等并发症。结论 在颈椎后路单开门椎管扩大椎板成形术中，C₂采用“穹顶”减压与椎板开门均可获得满意的减压效果，椎板开门可提供更彻底的减压，降低远期再狭窄风险，可能对保留脊髓的微观结构和轴索功能有积极意义。同时，更充分的脊髓漂移不一定会增加C₅神经根麻痹的风险。

Abstract:

      Objective To compare the efficacy and prognosis of different C₂ management strategies（dome-like expansive and expansive open-door） during cervical posterior single-door laminoplasty in the treatment of upper cervical ossification of the posterior longitudinal ligament（OPLL）. Methods From January 2022 to June 2024，71 patients with upper cervical OPLL were treated with cervical posterior single-door laminoplasty. Among them，39 patients underwent C₂ dome-like expansive（dome group） and 32 underwent expansive open-door（open-door group） during the operation. The Japanese Orthopaedic Association（JOA） score，visual analog scale（VAS） score，neck disability index（NDI），imaging indicators such as maximum canal stenosis rate（MCSR），cord posterior shift（CPS），and cervical range of motion（ROM） at pre- and post-operation，as well as postoperative complications were recorded. Results All the operations were successfully completed，and all the patients were followed up more than 12 months. The JOA scores，VAS scores，and NDI of both groups significantly improved at postoperative 12 months compared to the preoperative levels，all with a statistically significant difference（P < 0.05）. At postoperative 12 months，the VAS score of the dome group was better than that of the open-door group，and the difference was statistically significant（P < 0.05）；there was no statistically significant difference in JOA scores and NDI between the 2 groups（P > 0.05）. At postoperative 12 months，MCSR and CPS of both groups improved compared to the preoperative levels，while ROM decreased，and the differences were statistically significant（P < 0.05）. At postoperative 12 months，the MCSR and CPS of the open-door group were better than those of the dome group，and the ROM loss was also heavier than the dome group，all with a statistically significant difference（P < 0.05）. Both groups did not experience complications such as C₅ nerve root palsy or re-closure. Conclusions In the cervical posterior single-door laminoplasty，both C₂ dome-like expansive and C₂ expansive open-door can achieve satisfactory decompression results. C₂ expansive open-door can provide more thorough decompression，reduce the risk of long-term restenosis，and may has positive implication for preserving the microstructure and axonal function of the spinal cord. Meanwhile，more complete spinal drift does not necessarily increase the risk of C₅ nerve root palsy.