颈后路微创椎管扩大成形术治疗≥3 个节段脊髓型颈椎病的临床研究

Influence of posterior cervical minimally invasive laminoplasty on clinical efficacy and safety of cervical spondyloticmyelopathy patients with ≥3 segments

摘要:

目的 探讨颈后路微创椎管扩大成形术对≥3个节段脊髓型颈椎病患者疗效及安全性的影响。方法 选取2016年1月—2017年12月重庆市急救医疗中心收治的≥3个节段脊髓型颈椎病患者80例为研究对象。根据随 机数字表法分为对照组和微创组，每组40例。其中对照组采用颈后路常规椎管扩大成形术治疗；微创组采用颈后 路微创椎管扩大成形术治疗。比较两组手术时间、术中失血量、术后住院时间、总治疗费用、手术前后JOA评 分、颈椎曲度、颈椎曲度指数、颈椎活动度及椎轴性疼痛发生率。结果 两组手术时间、术中失血量及术后住院 时间比较，差异无统计学意义（P >0.05）；微创组总治疗费用低于对照组（P <0.05）；两组术后JOA评分高于术 前（P <0.05）；两组术后JOA评分比较，差异无统计学意义（P >0.05）；两组术后颈椎曲度、颈椎曲度指标及颈 椎活动度低于术前（P <0.05）；微创组术后颈椎曲度、颈椎曲度指标及颈椎活动度高于对照组（P <0.05）；微创 组轴性疼痛发生率低于对照组（P <0.05）。结论 颈后路微创椎管扩大成形术治疗≥3个节段脊髓型颈椎病可有效 保护颈椎曲度，提高颈椎活动度，降低治疗费用和轴性疼痛发生风险，且对颈椎神经活动功能改善效果不逊于常 规术式。

Abstract:

Objective To investigate the influence of posterior cervical minimally invasive laminoplasty on clinical efficacy and safety of cervical spondylotic myelopathy patients with ≥ 3 segments. Methods Eighty cervical spondylotic myelopathy patients with ≥ 3 segments were chosen from January 2016 to December 2017 in our hospital and randomly divided into 2 groups including control group (40 patients) with posterior cervical conventional laminoplasty and minimally invasive group (40 patients) with posterior cervical minimally invasive laminoplasty. The operation time, intraoperative blood loss, hospital staying time after operation, total treatment costs, JOA score, cervical curvature, cervical curvature index and cervical mobility before and after operation, and axial pain incidence of both groups were compared. Results There was no significant difference in the operation time, intraoperative blood loss, and hospital staying time after operation between 2 groups (P > 0.05). The total treatment costs of minimally invasive group were significant less than control group (P < 0.05). The JOA scores of 2 groups were significant higher after operation than before operation (P < 0.05). There was no significant difference in the JOA scores after operation between 2 groups (P > 0.05). The c cervical curvature, cervical curvature index, and cervical mobility of minimally invasive group were significant lower after operation than before operation (P < 0.05). The index above after operation of minimally invasive group were significant higher than those of control group (P < 0.05). Theaxial incidence of minimally invasive group were significant lower than that of control group (P < 0.05). Conclusion Posterior cervical minimally invasive laminoplasty in the treatment of cervical spondylotic myelopathy patients with ≥ 3 segments can efficiently protect cervical curvature, improve cervical mobility, reduce treatment costs and axial pain risk, and has the same improvement effects of cervical nerve function.