保留颈椎后部棘突肌肉韧带复合体的颈椎后路单开门椎管成形术的应用

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1、保留颈椎后部棘突肌肉韧带复合体的颈椎后路单开门椎管成形术的应用作者：陈少明,邱玉金,刘亚刘文华【摘要】目的探讨保留颈椎后部棘突肌肉韧带复合体的颈椎后路单开门椎管成形术在维持颈椎的稳定性、减少颈椎疾患术后轴性症状发生中的应用价值。方法选择脊髓型颈椎病(CSM)19例,颈椎后纵韧带骨化症(OPLL)16例,随机分为2组,A组共18例接受保留颈椎后部棘突肌肉韧带复合体的颈椎后路单开门椎管成形术,B组共17例接受传统颈椎后路单开门椎管成形术。对两组患者术后1年的JOA评分改善率、颈椎曲度指数、颈椎活动度及轴性症状严重程度进行比较评估。结果JOA评分

2、恢复率A组为(52.0±21.4)%,B组为(52.7±19.8)%,两组差异无统计学意义。A组术后有明显轴性症状者的比例为22.2%,B组为58.5%,两组比较差异有统计学意义(P<0.05)。A组患者术后颈椎曲度指数丢失(2.87±2.32)%,B组患者术后颈椎曲度指数丢失(5.51±2.11)%,两组患者手术前后颈椎曲度指数的变化差异有统计学意义(P<0.01)。A组患者术后颈椎活动度丢失(7.58±3.65)%,B组患者术后颈椎活动度丢失(5.51±2.11)%,两组差异有统计学意义(P<0.01)。结论保留颈椎后

3、部棘突肌肉韧带复合体对于其发挥维持颈椎生理曲度和颈椎的稳定性、减少术后轴性症状的发生等具有重要的临床意义。12【关键词】颈椎;棘突韧带复合体;单开门椎管成形术;轴性症状;生理曲度　　【Abstract】ObjectiveToverifywhetherthereservationofligamentmusclecomplex(LMC)ofposteriorcervicalspineiseffectiveonmaintainingthephysiologicalcervicalspinealignmentandthestabilityofce

4、rvicalspineinthetreatmentofcervicalspondyloticmyelopathy(CSM)andossificationofposteriorlongitudinal1igament(OPLL).Methods19patientswithCSMand16patientswithOPLLenrolledinthisstudywererandomlydividedintotwogroups.SubjectsingroupA(n=18)receivedsinglecervicalposterioropendoor

5、laminoplastywithretainedLMCwhilethoseingroupB(n=17)receivedtraditionalopendoorlaminoplasty.PostoperativeimprovementrateofJapaneseOrthopedicsAssociation(JOA)scores,thedegreeofaxialsymptom,rangesofneckmotionandcervicalcurvatureindiceswererecordedandcompared.ResultsTheaverag

6、eJOAimprovementratewas(52.0±21.4%)forgroupAand(52.7±19.8%)forgroupB,TherewasnosignificantdifferenceinJOAimprovementratebetweengroupAandgroupB[(52.0±21.4)vs(52.7±19.8)%].IngroupA,22.2%ofpatientshadevidentaxialsymptomscompared12with58.5%ingroupB(P<0.05).Lossofcervicalcurv

7、atureindiceswas(2.87±2.32)%ingroupAand(5.51±2.11)%ingroupB,andthedifferencewasstatisticallysignificant(P<0.01).SignificantdifferencewasalsofoundinlossofrangesofneckmotionbetweengroupAandgroupB[(7.58±3.65)%vs(5.51±2.11)%,P<0.01].PostoperativeMRIofpatientsingroupAindic

8、atedsufficientexpansionofthespinalcord.ConclusionRetainingLMCofcervicalposteriorspinouspr