保留頸椎后部棘突肌肉韌帶復合體的頸椎后路單開門椎管成形術的應用

【摘要】  目的 探討保留頸椎后部棘突肌肉韌帶復合體的頸椎后路單開門椎管成形術在維持頸椎的穩定性、減少頸椎疾患術后軸性癥狀發生中的應用價值。方法 選擇脊髓型頸椎病(CSM)19例,頸椎后縱韌帶骨化癥(OPLL)16例,隨機分為2組,A組共18例接受保留頸椎后部棘突肌肉韌帶復合體的頸椎后路單開門椎管成形術,B組共17例接受傳統頸椎后路單開門椎管成形術。對兩組患者術后1年的JOA評分改善率、頸椎曲度指數、頸椎活動度及軸性癥狀嚴重程度進行比較評估。結果 JOA評分恢復率A組為(52.0±21.4)%,B組為(52.7±19.8)%,兩組差異無統計學意義。A組術后有明顯軸性癥狀者的比例為22.2%,B組為58.5%,兩組比較差異有統計學意義(P<0.05)。A組患者術后頸椎曲度指數丟失(2.87±2.32)%,B組患者術后頸椎曲度指數丟失(5.51±2.11)%,兩組患者手術前后頸椎曲度指數的變化差異有統計學意義(P<0.01)。A組患者術后頸椎活動度丟失(7.58±3.65)%,B組患者術后頸椎活動度丟失(5.51±2.11)%,兩組差異有統計學意義(P<0.01)。結論 保留頸椎后部棘突肌肉韌帶復合體對于其發揮維持頸椎生理曲度和頸椎的穩定性、減少術后軸性癥狀的發生等具有重要的臨床意義。

【關鍵詞】  頸椎;棘突韌帶復合體;單開門椎管成形術;軸性癥狀;生理曲度工程師職稱論文發表

　　【Abstract】 Objective To verify whether the reservation of ligament�瞞uscle complex(LMC)of posterior cervical spine is effective on maintaining the physiological cervical spine alignment and the stability of cervical spine in the treatment of cervical spondylotic myelopathy(CSM)and ossification of posterior longitudinal 1igament(OPLL).Methods 19 patients with CSM and 16 patients with OPLL enrolled in this study were randomly divided into two groups.Subjects in group A(n=18)received single cervical posterior open�瞕oor laminoplasty with retained LMC while those in group B(n=17)received traditional open�瞕oor laminoplasty.Postoperative improvement rate of Japanese Orthopedics Association(JOA)scores,the degree of axial symptom,ranges of neck motion and cervical curvature indices were recorded and compared.Results The average JOA improvement rate was (52.0±21.4%) for group A and (52.7±19.8%) for group B,There was no significant difference in JOA improvement rate between group A and group B[(52.0±21.4)vs(52.7±19.8)%].In group A,22.2% of patients had evident axial symptoms compared with 58.5% in group B(P<0.05).Loss of cervical curvature indices was(2.87±2.32)% in group A and(5.51±2.11)% in group B,and the difference was statistically significant(P<0.01).Significant difference was also found in loss of ranges of neck motion between group A and group B[(7.58±3.65)% vs(5.51±2.11)%,P<0.01].Postoperative MRI of patients in group A indicated sufficient expansion of the spinal cord.Conclusion Retaining LMC of cervical posterior spinous process has important clinical significance for maintaining cervical lordosis and its stability as well as reducing the incidence of postoperative axial symptoms.

　　【Key words】 cervical vertebrae;ligamentous complex of posterior spinous process;single open�瞕oor laminoplasty;axial symptom;physiological curvature工程師職稱論文發表

　　傳統的頸椎后路單開門椎管擴大成形術雖然術后患者短期內神經癥狀較術前明顯緩解,但手術破壞了頸后方棘突肌肉韌帶復合體的完整性,術后常并發頸肩部疼痛、肌肉僵硬、頸椎生理曲度改變、頸椎運動范圍減小、頸椎不穩、術后再關門、軸性癥狀等[1]。保留頸椎后部棘突肌肉韌帶復合體的頸椎后路單開門椎管成形術最大限度地保留了頸椎后部的棘突肌肉韌帶復合體,盡可能地維持原有生物力學的基本結構。我們將保留頸椎后部棘突肌肉韌帶復合體的頸椎后路單開門椎管成形術應用于臨床,回顧性研究了我科2006年3月～2008年3月應用傳統頸椎后路單開門椎管成形術、保留頸椎后部棘突肌肉韌帶復合體的頸椎后路單開門椎管成形術治療35例頸椎疾患患者。并在此基礎上探討保留頸椎后部棘突肌肉韌帶復合體的頸椎后路單開門椎管成形術治療頸椎疾患術后在維持頸椎的穩定性、減少術后軸性癥狀發生中的臨床應用價值。

　　1 資料與方法工程師職稱論文發表

　　1.1 一般資料

　　頸椎疾患35例,其中男21例,女14例,年齡45～70歲,平均57.5歲。脊髓型頸椎病(cervical spondylotic myelopathy,CSM)19例,頸椎后縱韌帶骨化癥(ossification of posterior longitudinal 1igament,OPLL)16例;3個節段病變21例,4個節段病變14例。隨機分為2組,A組共18例接受保留頸椎后部棘突肌肉韌帶復合體的頸椎后路單開門椎管成形術,B組共17例接受傳統頸椎后路單開門椎管成形術。所有患者術前、術后均進行頸椎正側位、頸椎過伸過曲位線X片及頸椎MRI檢查。術后隨訪6～12個月,平均8.5個月。

　　1.2 手術方法及術后處理工程師職稱論文發表

　　保留頸椎后部棘突肌肉韌帶復合體的頸椎后路單開門椎管成