对称性颈椎后路椎管扩大椎板成形术治疗多节段脊髓型颈椎病

关键词：颈椎  颈椎病  减压术，外科

Keywords:Cervical vertebrae  Cervical spondylosis  Decompression,surgical

摘要：

      目的 探讨对称性颈椎后路椎管扩大椎板成形术治疗多节段脊髓型颈椎病（MCSM）的临床优势。方法 2020年9月—2021年9月收治MCSM患者54例，其中28例采用对称性颈椎后路椎管扩大椎板成形术治疗（对称组），26例采用颈椎后路单开门椎管扩大椎板成形术治疗（单开门组）。手术前后采用视觉模拟量表（VAS）评分评估颈部轴性疼痛程度，采用日本骨科学会（JOA）评分评估脊髓神经功能。在颈椎MRI T2WI上测量双侧颈后椎旁肌横截面积，并计算肌肉容积。记录2组术后并发症发生情况。结果 所有手术顺利完成，所有患者随访1年。2组患者术后VAS、JOA评分较术前显著改善，对称组术后VAS评分显著优于单开门组，差异均有统计学意义（P < 0.05）；2组术后JOA评分差异无统计学意义（P > 0.05）。对称组术后铰链侧、开门侧颈后椎旁肌肌肉容积与术前相比，差异均无统计学意义（P > 0.05）。单开门组术后铰链侧颈后椎旁肌肌肉容积较术前明显下降，差异有统计学意义（P < 0.05）；开门侧与术前相比，差异无统计学意义（P > 0.05）。组间比较，对称组术后铰链侧颈后椎旁肌肌肉容积显著大于单开门组，差异有统计学意义（P < 0.05）；2组术后开门侧颈后椎旁肌肌肉容积差异无统计学意义（P > 0.05）。对称组发生切口感染2例，并发症发生率为7.14%；单开门组发生切口感染2例，C₅神经根麻痹1例，并发症发生率为11.54%；2组并发症发生率差异无统计学意义（P > 0.05）。结论 对称性颈椎后路椎管扩大椎板成形术是治疗MCSM有效且可靠的术式，在保证与传统单开门手术神经减压效果相当的前提下，能更好地保护颈后肌肉结构与平衡性，降低术后轴性疼痛发生风险，值得临床推广。

Abstract:

      Objective To explore the clinical advantages of symmetrical posterior cervical laminoplasty in the treatment of multilevel cervical spondylotic myelopathy（MCSM）. Methods From September 2020 to September 2021，54 patients with MCSM were admitted. Among them，28 were treated with symmetrical posterior cervical laminoplasty（symmetrical group），and 26 with posterior cervical single-door laminoplasty（single-door group）. At pre- and post-operation，the intensity of axial neck pain was evaluated using the visual analogue scale（VAS） score，and the spinal nerve function was assessed using the Japanese Orthopaedic Association（JOA） score. On the cervical MRI T2WI，the cross-sectional area of the bilateral cervical posterior paraspinal muscles was measured，and the muscle volume was calculated. The occurrence of postoperative complications in both groups was recorded. Results All the surgeries were successfully completed，and all the patients were followed up for 1 year. The VAS and JOA scores in both groups significantly improved at post-operation compared to pre-operation. At post-operation，the VAS score of symmetrical group was significantly better than that of single-door group，and the difference was statistically significant（P < 0.05）；however，there was no statistically significant difference in the JOA scores between the 2 groups（P > 0.05）. There was no statistically significant difference in the muscle volume of the cervical posterior paraspinal muscles on the hinge and door-opening sides of the symmetrical group at post-operation compared to the preoperative levels（P > 0.05）. The muscle volume of the cervical posterior paraspinal muscles on the hinged side of the single-door group decreased significantly at post-operation compared to the preoperative level，with a statistically significant difference（P < 0.05）；however，there was no statistically significant difference on the hinged side compared to the preoperative levels（P > 0.05）. Inter group comparison showed that the muscle volume of the cervical posterior paraspinal muscles on the hinge side at post-operation in the symmetrical group was significantly larger than that in the single-door group，and the difference was statistically significant（P < 0.05）；and there was no statistically significant difference on the door-opening side between the 2 groups（P > 0.05）. In the symmetrical group，there were 2 cases of incision infection，with a complication rate of 7.14%；in the single-door group，there were 2 cases of incision infection and 1 of C₅ nerve root palsy，with a complication rate of 11.54%；and there was no statistically significant difference in the complication rates between the 2 groups（P > 0.05）. Conclusions The symmetrical posterior cervical laminoplasty is an effective and reliable surgical method for the treatment of MCSM. While ensuring the same nerve decompression effect as the traditional single-door surgery，it can better protect the posterior cervical muscle structure and balance，and reduce the risk of postoperative axial pain，and it is worthy of clinical promotion.