摘要
目的:观察全椎板减压侧块螺钉固定术与单开门钛板固定术治疗脊髓型颈椎病术后在神经功能、轴性症状及C5神经根神经麻痹上的差异。方法:选取在医院接受颈后路手术治疗的92例脊髓型颈椎病临床资料符合标准的患者,根据接受手术方式的不同将其分为观察组(45例)和对照组(47例),观察组采用全椎板减压侧块螺钉固定术治疗,对照组采用单开门椎管扩大成形钛板固定术治疗。术后采用日本骨科协会(JOA)脊髓损害评分表(17分法)评估手术前后神经恢复情况,观察两组患者颈椎活动度(ROM)、颈椎曲度指数(CCI)、脊髓漂移距离、轴性症状及C5神经根麻痹发生情况。结果:观察组患者的手术时间、术中出血量均高于对照组,差异有统计学意义(t=4.951,t=7.461;P<0.05);观察组患者椎板切除宽度和脊髓漂移距离分别为(17.2±2.8)mm和(2.4±0.6)mm,对照组分别为(22.5±3.2)mm和(2.6±0.7)mm,两组椎板切除宽度比较差异有统计学意义(t=8.439,P<0.05),脊髓漂移距离无统计学差异。观察组和对照组患者术后JOA评分较术前均显著增高,其差异有统计学意义(F=50.734,F=52.638;P<0.05)。观察组患者术后较术前CCI有显著改善,其差异有统计学意义(F=15.360,P<0.05);对照组CCI则出现显著丢失(F=12.962,P<0.05)。观察组患者ROM丢失程度显著高于对照组,其差异有统计学意义(t=10.549,P<0.05)。观察组C5神经根麻痹发生率为8.9%,对照组发生率为6.4%,两组比较差异无统计学差异。结论:侧块螺钉在恢复颈椎曲度与微型钛板相比具有优势,但术后颈椎活动度丢失较多,故适当缩小椎板切除宽度与单开门均可限制脊髓向后漂移,可降低C5神经根麻痹及轴性症状的发生。
Objective: To observe the difference of whole laminectomy with screw fixation of lateral mass and singledoor laminoplasty in treating postoperative neurological functions, axial symptoms and neural paralysis of C5 nerve root of multilevel cervical spondylotic myelopathy(M-CSM). Methods: 92 patients with cervical spondylotic myelopathy whose clinical documents were consistent with standards, and who underwent posterior approach operation of neck in hospital were selected. According to the received different operation method, they were divided into observation group(n=45 cases) and control group(47 cases). Observation group adopted whole laminectomy with screw fixation of lateral mass to implement treatment, and control group adopted single-door laminoplasty to implement treatment. The spinal cord lesions scale of Japanese Orthopaedic Association(JOA) was used to assess the recovery situation of nerve pre and post operation. The cervical range of motion(ROM), cervical curvature index(CCI), drift distance of spinal cord, axial symptoms and neural palsy of C5 centrum of two groups were compared. Results: The operative time and intraoperative blood loss of observation group were significantly higher than those of observation group(t=4.951, t=7.461, P<0.05). The laminectomy width and drift distance of spinal cord were(17.2±2.8) mm and(2.4±0.6) mm in observation group, respectively. And that was(22.5±3.2) mm and(2.6±0.7) mm in control group, respectively. There was significant difference in laminectomy width between two groups(t=8.439, P<0.05), while the difference of drifting distance of spinal cord between two groups was no significant. The postoperative JOA scores of two groups were significantly higher than preoperative level of two groups(F=50.734, F=52.638, P<0.05). And compared with preoperative CCI of observation group, the postoperative CCI of observation group was significantly improved(F=15.360, P<0.05). But the CCI of control group was significantly lost(F=12.962, P<0.05). The lost degree of ROM of obser
作者
李敏
吴椰明
王瑞
田金辉
LI Min;WU Ye-ming;WANG Rui(Operating Room,Handan People's Hospital,Handan 056001,China)
出处
《中国医学装备》
2020年第4期114-118,共5页
China Medical Equipment
基金
河北省医学科学研究重点课题计划(20191830)“有限椎板切除联合神经根管减压治疗脊髓型颈椎病的临床疗效研究”。
关键词
脊髓型颈椎病
全椎板减压
侧块螺钉固定
C5神经根麻痹
轴性症状
Cervical spondylotic myelopathy
Laminectomy
Screw fixation of lateral mass
C5 nerve palsy
Axial symptoms
