頸椎后路單開門椎管擴大成形術范圍延至寰椎的手術指征探討_《中國修復重建外科雜志》

作者：

李清江 ^1,2 , 孔清泉 ² , 張立 ³ , 孫天威 ¹ , 李濤 ² , 龔全 ² , 宋躍明 ² , 劉浩 ²

1天津醫科大學天津市人民醫院脊柱外科（天津，300070）;;
2四川大學華西醫院骨科;;
3 北京大學第三醫院骨科;

關鍵詞：

單開門椎管擴大成形術椎管減壓頸椎管狹窄后縱韌帶骨化

DOI：

10.7507/1002-1892.20130266

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的探討頸椎后路單開門椎管擴大成形術范圍延至寰椎的手術指征。方法篩選2005年9月－2010年1月收治的頸椎C3～7或C2～7單開門椎管擴大成形術后，因C1～4范圍內狹窄導致脊髓損害癥狀不緩解或緩解后再次加重，再手術將減壓節段延伸至C1節段的后縱韌帶骨化患者，排除因手術本身原因所致的再手術者，共17例作為研究組，并與因頸椎管狹窄癥行C2～7減壓聯合C1后弓切除術患者15例（對照組）進行比較。兩組患者性別、年齡、病程等一般資料比較差異均無統計學意義（P gt; 0.05），具有可比性。根據患者影像學資料評估其手術前后頸椎曲度及脊髓受壓情況；應用日本骨科協會（JOA）脊髓功能17分評分表和Frankel分級評價患者手術前后神經功能情況；通過Hirabayashi等方法評估術后神經功能改善情況。結果研究組17例患者中，初次行C3～7椎管擴大成形8例，其中3例存在C1、2節段狹窄，脊髓周圍腦脊液信號不連續；5例在C2～4節段有最大前后徑 gt; 7.0 mm的致壓物。初次行C2～7椎管擴大成形術9例，C2～4節段均有最大前后徑 gt; 7.0 mm的致壓物。17例患者再次手術將減壓節段延至C1，術后隨訪時間35～61個月，平均45.6個月；頸椎曲度情況：術前為頸椎前凸11例、直形頸椎4例、頸椎后凸2例，術后有2例頸椎前凸變為直形頸椎，1例直形頸椎變為后凸；神經改善率優8例，良7例，可2例。對照組術前C2～4節段均有最突出部位前后徑 gt; 7.0 mm的致壓物；術后隨訪時間30～58個月，平均38.7個月；頸椎曲度情況：術前為頸椎前凸13例、直形頸椎2例，術后有1 例頸椎前凸變為直形頸椎；神經功能恢復率為優8例，良6例，可1例。術前及末次隨訪時兩組組間比較JOA評分差異均無統計學意義（P gt; 0.05），兩組末次隨訪時JOA 評分均較術前顯著改善（P lt; 0.05）。結論對于頸椎后路單開門椎管擴大成形術范圍延至寰椎的手術指征，初步提出以下幾點：①上頸椎（C1、2）椎管狹窄，判定標準為：C1后弓下緣以上部分脊髓周圍腦脊液信號不連續，且椎管實際前后徑 lt; 8.0 mm。②C2～4椎體下緣節段存在巨大致壓物，最突出部位直徑 gt; 7.0 mm，無法通過頸椎前路手術去除致壓因素，或前路手術風險性極大時。

引用本文： 李清江,孔清泉,張立,孫天威,李濤,龔全,宋躍明,劉浩. 頸椎后路單開門椎管擴大成形術范圍延至寰椎的手術指征探討. 中國修復重建外科雜志, 2013, 27(10): 1214-1220. doi: 10.7507/1002-1892.20130266 復制

1.	Mitsunage LK, Klineberg EO, Gupta MC. Laminoplasty techniques for the treatment of multilevel cervical stenosis. Adv Orthop, 2012, 2012: 307916.
2.	Hirabayashi K, Miyakawa J, Satomi K, et al. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976), 1981, 6(4): 354-364.
3.	Nolan JP Jr, Sherk HH. Biomechanical evaluation of the extensor musculature of the cervical spine. Spine (Phila Pa 1976), 1988, 13(1): 9-11.
4.	Takeshita K, Peterson ET, Bylski-Austrow D, et al. The nuchal ligament restrains cervical spine flexion. Spine (Phila Pa 1976), 2004, 29(18): E388-393.
5.	Liu J, Ebraheim NA, Sanford CG, et al. Preservation of the spinous process-ligament-muscle complex to prevent kyphotic deformity following laminoplasty. Spine J, 2007, 7(2): 159-164.
6.	Hosono N, Sakaura H, Mukai Y, et al. C3-6 laminoplasty takes over C3-7 laminoplasty with significantly lower incidence of axial neck pain. Eur Spine J, 2006, 15(9): 1375-1379.
7.	Sakaura H, Hosono N, Mukai Y, et al. Preservation of muscles attached to the C2 and C7 spinous processes rather than subaxial deep extensors reduces adverse effects after cervical laminoplasty. Spine (Phila Pa 1976), 2010, 35(16): E782-786.
8.	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 Spinal Disord Tech, 2008, 21(5): 338-343.
9.	Takeuchi K, Yokoyama T, Aburakawa S, et al. Postoperative changes at the lower end of cervical laminoplasty: for preservation of the C7 spinous process in laminoplasty. J Spinal Disord Tech, 2006, 19(6): 402-406.
10.	Takeuchi T, Shono Y. Importance of preserving the C7 spinous process and attached nuchal ligament in French-door laminoplasty to reduce postoperative axial symptoms. Eur Spine J, 2007, 16(9): 1417-1422.
11.	Yasuoka S, Peterson HA, MacCarty CS. Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg, 1982, 57(4): 441-445.
12.	Katsumi Y, Honma T, Nakamura T. Analysis of cervical instability resulting from laminectomies for removal of spinal cord tumor. Spine (Phila Pa 1976), 1989, 14(11): 1171-1176.
13.	Inoue A, Ikata T, Katoh S. Spinal deformity following surgery for spinal cord tumors and tumorous lesions: analysis based on an assessment of the spinal functional curve. Spinal Cord, 1996, 34(9): 536-542.
14.	Steinbok P, Boyd M, Cochrane D. Cervical spinal deformity following craniotomy and upper cervical laminectomy for posterior fossa tumors in children. Childs Nerv Syst, 1989, 5(1): 25-28.
15.	Zhang J, Hirabayashi S, Saiki K, et al. Effectiveness of multiple-level decompression in laminoplasty and simultaneous C1 laminectomy for patients with cervical myelopathy. Eur Spine J, 2006, 15(9): 1367-1374.
16.	Takeshita K, Seichi A, Akune T, et al. Can laminoplasty maintain the cervical alignment even when the C2 lamina is contained? Spine (Phila Pa 1976), 2005, 30(11): 1294-1298.
17.	Kong Q, Zhang L, Liu L, et al. Effect of the decompressive extent on the magnitude of the spinal cord shift after expansive open-door laminoplasty. Spine (Phila Pa 1976), 2011, 36(13): 1030-1036.
18.	Lee JY, Sharan A, Baron EM, et al. Quantitative prediction of spinal cord drift after cervical laminectomy and arthrodesis. Spine (Phila Pa 1976), 2006, 31(16): 1795-1798.
19.	Kawakami M, Tamaki T, Ando M, et al. Relationships between sagittal alignment of the cervical spine and morphology of the spinal cord and clinical outcomes in patients with cervical spondylotic myelopathy treated with expansive laminoplasty. J Spinal Disord Tech, 2002, 15(5): 391-397.
20.	Baba H, Uchida K, Maezawa Y, et al. Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: a magnetic resonance imaging study. J Neurol, 1996, 243(9): 626-632.
21.	Sodeyama T, Goto S, Mochizuki M, et al. Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine (Phila Pa 1976), 1999, 24(15): 1527-1532.

1. Mitsunage LK, Klineberg EO, Gupta MC. Laminoplasty techniques for the treatment of multilevel cervical stenosis. Adv Orthop, 2012, 2012: 307916.
2. Hirabayashi K, Miyakawa J, Satomi K, et al. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976), 1981, 6(4): 354-364.
3. Nolan JP Jr, Sherk HH. Biomechanical evaluation of the extensor musculature of the cervical spine. Spine (Phila Pa 1976), 1988, 13(1): 9-11.
4. Takeshita K, Peterson ET, Bylski-Austrow D, et al. The nuchal ligament restrains cervical spine flexion. Spine (Phila Pa 1976), 2004, 29(18): E388-393.
5. Liu J, Ebraheim NA, Sanford CG, et al. Preservation of the spinous process-ligament-muscle complex to prevent kyphotic deformity following laminoplasty. Spine J, 2007, 7(2): 159-164.
6. Hosono N, Sakaura H, Mukai Y, et al. C3-6 laminoplasty takes over C3-7 laminoplasty with significantly lower incidence of axial neck pain. Eur Spine J, 2006, 15(9): 1375-1379.
7. Sakaura H, Hosono N, Mukai Y, et al. Preservation of muscles attached to the C2 and C7 spinous processes rather than subaxial deep extensors reduces adverse effects after cervical laminoplasty. Spine (Phila Pa 1976), 2010, 35(16): E782-786.
8. 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 Spinal Disord Tech, 2008, 21(5): 338-343.
9. Takeuchi K, Yokoyama T, Aburakawa S, et al. Postoperative changes at the lower end of cervical laminoplasty: for preservation of the C7 spinous process in laminoplasty. J Spinal Disord Tech, 2006, 19(6): 402-406.
10. Takeuchi T, Shono Y. Importance of preserving the C7 spinous process and attached nuchal ligament in French-door laminoplasty to reduce postoperative axial symptoms. Eur Spine J, 2007, 16(9): 1417-1422.
11. Yasuoka S, Peterson HA, MacCarty CS. Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg, 1982, 57(4): 441-445.
12. Katsumi Y, Honma T, Nakamura T. Analysis of cervical instability resulting from laminectomies for removal of spinal cord tumor. Spine (Phila Pa 1976), 1989, 14(11): 1171-1176.
13. Inoue A, Ikata T, Katoh S. Spinal deformity following surgery for spinal cord tumors and tumorous lesions: analysis based on an assessment of the spinal functional curve. Spinal Cord, 1996, 34(9): 536-542.
14. Steinbok P, Boyd M, Cochrane D. Cervical spinal deformity following craniotomy and upper cervical laminectomy for posterior fossa tumors in children. Childs Nerv Syst, 1989, 5(1): 25-28.
15. Zhang J, Hirabayashi S, Saiki K, et al. Effectiveness of multiple-level decompression in laminoplasty and simultaneous C1 laminectomy for patients with cervical myelopathy. Eur Spine J, 2006, 15(9): 1367-1374.
16. Takeshita K, Seichi A, Akune T, et al. Can laminoplasty maintain the cervical alignment even when the C2 lamina is contained? Spine (Phila Pa 1976), 2005, 30(11): 1294-1298.
17. Kong Q, Zhang L, Liu L, et al. Effect of the decompressive extent on the magnitude of the spinal cord shift after expansive open-door laminoplasty. Spine (Phila Pa 1976), 2011, 36(13): 1030-1036.
18. Lee JY, Sharan A, Baron EM, et al. Quantitative prediction of spinal cord drift after cervical laminectomy and arthrodesis. Spine (Phila Pa 1976), 2006, 31(16): 1795-1798.
19. Kawakami M, Tamaki T, Ando M, et al. Relationships between sagittal alignment of the cervical spine and morphology of the spinal cord and clinical outcomes in patients with cervical spondylotic myelopathy treated with expansive laminoplasty. J Spinal Disord Tech, 2002, 15(5): 391-397.
20. Baba H, Uchida K, Maezawa Y, et al. Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: a magnetic resonance imaging study. J Neurol, 1996, 243(9): 626-632.
21. Sodeyama T, Goto S, Mochizuki M, et al. Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine (Phila Pa 1976), 1999, 24(15): 1527-1532.

《中國修復重建外科雜志》

頸椎后路單開門椎管擴大成形術范圍延至寰椎的手術指征探討

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

《中國修復重建外科雜志》

頸椎后路單開門椎管擴大成形術范圍延至寰椎的手術指征探討

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料