單開門椎管成形術與全椎板減壓融合內固定術治療脊髓型頸椎病的臨床療效比較_《中國修復重建外科雜志》

作者：

張杭 , 孫天威 , 盧守亮 , 李清江 , Sandip Kumar Yadav

天津醫科大學天津市人民醫院脊柱外科（天津，300070）;

關鍵詞：

脊髓型頸椎病單開門椎管成形術全椎板減壓融合軸性癥狀

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目的探討頸后路單開門椎管成形術與全椎板減壓側塊螺釘植骨融合內固定術治療脊髓型頸椎病的臨床療效。方法2006年9月－2009 年9月，對143例多節段（≥3個）脊髓型頸椎病患者分別采用頸后路單開門擴大椎管成形術（A組，87例）及全椎板減壓側塊螺釘植骨融合內固定術（B組，56例）治療，兩組患者性別、年齡、病程、病變分型、病變節段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。隨訪觀察并比較兩組患者手術時間、術中出血量、術后神經功能恢復[采用日本骨科協會（JOA）17 分評分法]及手術并發癥發生情況，并對兩組患者手術前后頸椎曲率指數（cervical curvature index，CCI）、頸椎活動度（range of motion，ROM）及頸肩部疼痛[采用疼痛視覺模擬評分（VAS）及頸椎功能障礙指數量表（NDI）評分]等指標進行評估。結果兩組患者手術時間和術中出血量比較差異均無統計學意義（P gt; 0.05）。兩組患者均獲隨訪，隨訪時間18～30個月，平均24個月。A、B組術后分別有4例（4.60%）和5例（8.93%）出現C5神經根麻痹癥狀，比較差異無統計學意義（χ2=0.475，P=0.482）。兩組術后均無深部感染、假關節形成及螺釘松動需再手術等并發癥發生。A組患者術后均無椎板再關門發生；B組患者末次隨訪時無螺釘脫出、斷裂及繼發神經損傷等發生。末次隨訪時A、B組分別有35例（40.23%）和11例（19.64%）有頸部軸性癥狀，比較差異有統計學意義（χ2=6.612，P=0.009）。兩組患者術前JOA評分、CCI、頸椎ROM及VAS評分比較差異均無統計學意義（P gt; 0.05）；末次隨訪時兩組JOA評分、頸椎ROM、VAS評分及A組CCI均較術前有顯著改善（P lt; 0.05）。末次隨訪時，A、B組間JOA評分及改善率、VAS評分比較差異均無統計學意義（P gt; 0.05）；A組ROM大于B組，CCI小于B組，差異有統計學意義（P lt; 0.05）；末次隨訪時NDI評分，A組在疼痛程度、上舉能力、工作、駕車、反應及總分方面均顯著優于B組（P lt; 0.05）。結論兩種手術方式在術后神經功能改善率上無明顯差異，全椎板減壓植骨融合內固定術能有效緩解術前疼痛，但頸椎活動度降低較大；單開門椎管成形術并發癥較少，近期療效滿意。

引用本文： 張杭,孫天威,盧守亮,李清江,Sandip Kumar Yadav. 單開門椎管成形術與全椎板減壓融合內固定術治療脊髓型頸椎病的臨床療效比較. 中國修復重建外科雜志, 2012, 26(10): 1191-1196. doi: 復制

1.	Houten JK, Cooper PR. Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery, 2003, 52(5): 1081-1088.
2.	Heller JG, Edwards CC II, Murakami H, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine (Phila Pa 1976), 2001, 26(12): 1330-1336.
3.	Highsmith JM, Dhall SS, Haid RW Jr, et al. Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion. J Neurosurg Spine, 2011, 14(5): 619-625.
4.	Manzano GR, Casella G, Wang MY, et al. A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy. Neurosurgery, 2012, 70(2): 264-277.
5.	孫天威, 張杭, 盧守亮, 等. 頸椎單開門椎管擴大椎板成形術后鉸鏈側C5神經根麻痹與不同椎板開門角度的臨床分析. 中國修復重建外科雜志, 2011, 25(11): 1285-1289.
6.	Magerl F, Seemann PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation//Kehr P, Weidner A. Cervical Spine. New York: Springer-Verlag, 1987: 322-327.
7.	Takeshita K, Murakami M, Kobayashi A, et al. Relationship between cervical curvature index (Ishihara) and cervical spine angle (C2-7). J Orthop Sci, 2001, 6(3): 223-236.
8.	Barrett I, Justin H, Joon L, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy. Clin Orthop Relat Res, 2011, 469(3): 688-695.
9.	Chiba K, Ogawa Y, Ishii K, et al. Long-term results of expansive open-door laminoplasty for cervical myelopathy—average 14-year follow-up study. Spine (Phila Pa 1976), 2006, 31(26): 2998-3005.
10.	Mitsunage LK, Klineberg EO, Gupta MC. Laminoplasty techniques for the treatment of multilevel cervical stenosis. Adv Orthop, 2012, 2012: 307916.
11.	Iwasaki M, Okuda SY, Miyauchi A, et al. Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 1: Clinical results and limitations of laminoplasty. Spine (Phila Pa 1976), 2007, 32(6): 647-653.
12.	Yamazaki A, Homma T, Uchiyama S, et al. Morphologic limitations of posterior decompression by midsagittal splitting method for myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine. Spine (Phila Pa 1976), 1999, 24(1): 32-34.
13.	Hatta Y, Shiraishi T, Hase H, et al. Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy? Spine (Phila Pa 1976), 2005, 30(21): 2414-2419.
14.	Sakaura H, Hosono N, Mukai Y, et al. Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation: a comparative study of laminoplasty and anterior spinal fusion. Spine (Phila Pa 1976), 2005, 30(7): 756-759.
15.	Hosono N, Sakaura H, Mukai Y, et al. The source of axial pain after cervical laminoplasty-C7 is more crucial than deep extensor muscles. Spine (Phila Pa 1976), 2007, 32(26): 2985-2988.
16.	Roy-Camile R, Saillant G, Mazel C. Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plate and screw//Cervical Spine Research Society. The Cervical Spine. 2nd ed. Philadelphia Pa: JB Lippincott, 1989: 390-403.
17.	Coe JD, Warden KE, Sutterlin CE, et al. Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine (Phila Pa 1976), 1989, 14(10): 1122-1131.
18.	Nassr A, Eck JC, Ponnappan RK, et al. The incidence of C5 Palsy after multilevel cervical decompression procedures: A review of 750 consecutive cases. Spine (Phila Pa 1976), 2012, 37(3): 174-178.
19.	Imagama S, Matsuyama Y, Yukawa Y, et al. C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg (Br), 2010, 92(3): 393-400.
20.	Kaiser MG , Mummaneni PV, Matz PG, et al. Radiographic assessment of cervical subaxial fusion. J Neurosurg Spine, 2009, 11(2): 221-227.
21.	阮狄克. 頸椎融合加速相鄰節段退變: 真實還是虛構？中國脊柱脊髓雜志, 2011, 21(1): 6-7.
22.	王義生. 脊柱融合術與非融合術不是相互替代而是互補？中國脊柱脊髓雜志, 2011, 21(1): 7-8.
23.	Wang MY, Green BA, Vitarbo E, et al. Adjacent segment disease: an uncommon complication after cervical expansile laminoplasty: case report. Neurosurgery, 2003, 53(3): 770-773.
24.	Huang RC, Girardi FP, Poynton AR, et al. Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft. J Spinal Disord Tech, 2003, 16(2): 123-129.
25.	Takeuchi K, Yokoyama T, Aburakawa S, et al. Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-C7 laminoplasty: a modified laminoplasty preserving the semispinalis cervicis inserted into axis. Spine (Phila Pa 1976), 2005, 30(22): 2544-2549.
26.	Takeuchi K, Yokoyama T, Ono A, et al. Cervical range of motion and alignment after laminoplasty preserving or reattaching the semispinalis cervicis inserted into axis. J Spinal Disord Tech, 2007, 20(8): 571-576.

1. Houten JK, Cooper PR. Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery, 2003, 52(5): 1081-1088.
2. Heller JG, Edwards CC II, Murakami H, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine (Phila Pa 1976), 2001, 26(12): 1330-1336.
3. Highsmith JM, Dhall SS, Haid RW Jr, et al. Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion. J Neurosurg Spine, 2011, 14(5): 619-625.
4. Manzano GR, Casella G, Wang MY, et al. A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy. Neurosurgery, 2012, 70(2): 264-277.
5. 孫天威, 張杭, 盧守亮, 等. 頸椎單開門椎管擴大椎板成形術后鉸鏈側C5神經根麻痹與不同椎板開門角度的臨床分析. 中國修復重建外科雜志, 2011, 25(11): 1285-1289.
6. Magerl F, Seemann PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation//Kehr P, Weidner A. Cervical Spine. New York: Springer-Verlag, 1987: 322-327.
7. Takeshita K, Murakami M, Kobayashi A, et al. Relationship between cervical curvature index (Ishihara) and cervical spine angle (C2-7). J Orthop Sci, 2001, 6(3): 223-236.
8. Barrett I, Justin H, Joon L, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy. Clin Orthop Relat Res, 2011, 469(3): 688-695.
9. Chiba K, Ogawa Y, Ishii K, et al. Long-term results of expansive open-door laminoplasty for cervical myelopathy—average 14-year follow-up study. Spine (Phila Pa 1976), 2006, 31(26): 2998-3005.
10. Mitsunage LK, Klineberg EO, Gupta MC. Laminoplasty techniques for the treatment of multilevel cervical stenosis. Adv Orthop, 2012, 2012: 307916.
11. Iwasaki M, Okuda SY, Miyauchi A, et al. Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 1: Clinical results and limitations of laminoplasty. Spine (Phila Pa 1976), 2007, 32(6): 647-653.
12. Yamazaki A, Homma T, Uchiyama S, et al. Morphologic limitations of posterior decompression by midsagittal splitting method for myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine. Spine (Phila Pa 1976), 1999, 24(1): 32-34.
13. Hatta Y, Shiraishi T, Hase H, et al. Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy? Spine (Phila Pa 1976), 2005, 30(21): 2414-2419.
14. Sakaura H, Hosono N, Mukai Y, et al. Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation: a comparative study of laminoplasty and anterior spinal fusion. Spine (Phila Pa 1976), 2005, 30(7): 756-759.
15. Hosono N, Sakaura H, Mukai Y, et al. The source of axial pain after cervical laminoplasty-C7 is more crucial than deep extensor muscles. Spine (Phila Pa 1976), 2007, 32(26): 2985-2988.
16. Roy-Camile R, Saillant G, Mazel C. Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plate and screw//Cervical Spine Research Society. The Cervical Spine. 2nd ed. Philadelphia Pa: JB Lippincott, 1989: 390-403.
17. Coe JD, Warden KE, Sutterlin CE, et al. Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine (Phila Pa 1976), 1989, 14(10): 1122-1131.
18. Nassr A, Eck JC, Ponnappan RK, et al. The incidence of C5 Palsy after multilevel cervical decompression procedures: A review of 750 consecutive cases. Spine (Phila Pa 1976), 2012, 37(3): 174-178.
19. Imagama S, Matsuyama Y, Yukawa Y, et al. C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg (Br), 2010, 92(3): 393-400.
20. Kaiser MG , Mummaneni PV, Matz PG, et al. Radiographic assessment of cervical subaxial fusion. J Neurosurg Spine, 2009, 11(2): 221-227.
21. 阮狄克. 頸椎融合加速相鄰節段退變: 真實還是虛構？中國脊柱脊髓雜志, 2011, 21(1): 6-7.
22. 王義生. 脊柱融合術與非融合術不是相互替代而是互補？中國脊柱脊髓雜志, 2011, 21(1): 7-8.
23. Wang MY, Green BA, Vitarbo E, et al. Adjacent segment disease: an uncommon complication after cervical expansile laminoplasty: case report. Neurosurgery, 2003, 53(3): 770-773.
24. Huang RC, Girardi FP, Poynton AR, et al. Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft. J Spinal Disord Tech, 2003, 16(2): 123-129.
25. Takeuchi K, Yokoyama T, Aburakawa S, et al. Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-C7 laminoplasty: a modified laminoplasty preserving the semispinalis cervicis inserted into axis. Spine (Phila Pa 1976), 2005, 30(22): 2544-2549.
26. Takeuchi K, Yokoyama T, Ono A, et al. Cervical range of motion and alignment after laminoplasty preserving or reattaching the semispinalis cervicis inserted into axis. J Spinal Disord Tech, 2007, 20(8): 571-576.

《中國修復重建外科雜志》

單開門椎管成形術與全椎板減壓融合內固定術治療脊髓型頸椎病的臨床療效比較

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《中國修復重建外科雜志》

單開門椎管成形術與全椎板減壓融合內固定術治療脊髓型頸椎病的臨床療效比較

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

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