颈椎后路三种手术方式对改善多节段颈椎病生理曲度及疗效的远期观察

目的]本研究通过回顾性分析行颈椎后路手术的多节段脊髓型颈椎病合并后纵韧带骨化(ossificationofposteriorlongitudinalligament.OPLL)患者的颈椎曲率变化、JOA评分改善率以及颈肩轴性痛VAS评分改善率,比较颈椎后路三种手术方式对改善颈椎曲度、神经功能及轴性症状的远期影响.方法]根据手术方式分三组:A组颈椎后路单开门椎管扩大成形术29例,B组颈椎后路全椎板切除术23例,C组颈椎后路全椎板切除侧块螺钉内固定术26例,记录术前、术后的颈椎曲度、JOA评分及轴性症状等.结果]JOA评分改善率:3组患者术后与术前相比均有统计学意义(P＜0.05).末次随访时c组最高.颈椎曲度改善率:C组最好,A组次之,B组最差.并发症发生情况:在轴性症状上,3组的VAS评分两两比较有统计学意义(P＜0.05),B组最高,A组次之,C组最低.结论]采用颈椎后路三种手术方式治疗多节段脊髓型颈椎病合并OPLL均能达到良好的疗效.颈椎后路全椎板切除侧块螺钉内固定术可有效改善神经功能,恢复和保持颈椎曲度,降低轴性症状及C5神经根麻痹发生率.

Long-term influence of three cervical posterior operative methods for multilevel cervical spondylotic myelopathy:a retrospective study of cervical curvature and clinical outcomes

Objective]This study was to analyze the cervical curvature changes,JOA score recovery rate,VAS score recovery rate(cervical and shoulder axial pain) of the patients with multilevel cervical spondylotic myelopathy(CSM) combined ossification of posterior longitudinal ligament(OPLL) which were performed by three different cervical posterior surgical procedures through a retrospective control study,and to explore the long-term influence of three cervical posterior operative procedures to cervical curvature,neurologic function and axial symptoms.Methods]According to the surgical procedures,78 patients were divided into three groups: Group A(expansive open-door laminoplasty) comprised 29 patients,Group B(laminectomy) comprised 23 patients,Group C(laminectomy and lateral mass screw fixation) comprised 26 patients.The preoperative and postoperative cervical cuvature,JOA score,axial symptoms,ect were recorded.Results]The improvement rate of JOA score:there were significant difference between postoperative symptoms and preoperative symptoms of three groups(P<0.05).In the final follow-up,neurological recovery rate was highest in group C.The improvement rate of cervical curvature:it was best in group C,secondary in group A,poor in group B.Complications:there were significant differences for VAS score of cervical and shoulder axial pain among group A,group B and groupC(P<0.05),with an highest incidence in group B,secondary in group A,lowest in group C.Conclusion]Three cervical posterior surgical procedures for multilevel CSM combined OPLL all can achieve satisfactory results.Laminectomy and lateral mass screw fixation(group C) can effectively improve neurological function,recover and maintain cervical curvature and reduce the incidence of axial symptoms and C5 nerve root palsy.