改良颈后路单开门椎板成形术治疗多节段脊髓型颈椎病与传统术式疗效比较
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郑州市骨科医院

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Revised Posterior Unilateral Open-door Laminoplasty to Treat Multiple-segment Cervical Spondylosis Myelopathy
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Zhengzhou Orthopaedics Hospital

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    摘要:

    目的:探究改良颈后路单开门椎板成形术术后的临床疗效及影像学改变,并与传统术式进行比较。方法:前瞻性研究。制定颈后路手术治疗的纳入、排除标准,并经医院伦理委员会批准。将符合标准的患者根据入院顺序间隔分组,分为传统手术组(颈3-7单开门)与改良手术组(颈3-6单开门+潜行颈7椎板内板切除),定期随访。收集患者的一般资料、影像学资料、术中资料、JOA评分及术后并发症发生情况。应用SPSS-20进行统计学数据分析。定量资料用平均数±标准差(?x±s)表示,应用t检验比较分析;定性资料应用χ2检验;P<0.05为差异具有统计学意义。结果:2012年7月-2014年3月共收治多节段脊髓型颈椎病(≥3节段)298例,根据纳入、排除标准及随访情况;最终纳入研究:传统组40人、改良组38人。随访时间:传统组16.9±5.6月(14-48月),改良组17.1±6.1月(15-21月)。两组之间比较,年龄、性别组成、受累节段、术中出血量、手术时间均无统计学差异(P>0.1)。术后累计引流量,改良组明显减少,组间比较有统计学差异。术前mJOA评分、颈椎活动度、颈椎前凸度,组间比较没有统计学差异。术后末次随访时,改良组总体并发症发生率较低,组间比较有统计学差异,其中轴性疼痛的发病率改良组较少。 结论:改良颈后路单开门椎板成形术治疗多节段脊髓型颈椎病能够获得与传统术式相同的良好疗效和影像学结果;其在减少术后轴性疼痛发生率和减少翻修手术方面,改良手术优于传统手术。

    Abstract:

    OBJECTIVE:To explore the availability of revised posterior unilateral open-door laminoplasty through iconography parameters,clinical outcomes to multiple-segment cervical spondylosis myelopathy;and to compare with traditional operative procedure. METHODS:Prospective study.Disign the inclusive and exclusive criterions of patients suffering cervical spondylosis myelopathy. The study was authorized by the Hospital's Ethics Committee. The patients and relations were informed consent.And,patients participated in study were labeled based on the admitted order.Then odd labeled patients were implemented traditional single open-door and even labeled patients revised procedures.Fathermore,they all were follow-up according to same protocolplaned preoperatively,which included clinical evaluations(mJOA score),iconography parameters(cervical ROM(Range of Movement),cervical lordosis,spinal canal expansive ratio and spinal cord posterior shift score).The data were analysed by SPSS-20. RESULTS:85 patients underwent laminoplasty surgery after preoperative informed consent.According to categories,43 got C3-7 single open-door laminaplasty and 42 revised procedures.Exceptmissed followed patients,78 patients followed rountingly. Traditional surgery group’s average following-up time is 16.9±5.6months,and revised surgery group 17.1±6.1months.There were no difference about age,agender,segments suffered,intraoperative blood loss,surgery time.And,But,there was signiffcant difference between postoperative drainage volume.Iconography parameters are similar between groups.At the last following-up,there was no difference of overall complications between groups,but less axial pain happened at revised group. CONCLUSION: Revised unilateral open-door laminoplasty is an safe and valid procedure to multiple cervical spondylosis myelopathy,compared to traditional procedure.Both have similarly good clinal outcome and iconography parameters.But,there are less axial pain and revision surgery in revised group.

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  • 收稿日期:2020-03-08
  • 最后修改日期:2020-03-08
  • 录用日期:2020-04-15
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