[1]江泽华 程招军 方钊 万军 张学利△.C7棘突在颈椎后路椎管扩大成形术中对轴性症状的影响[J].中国中医骨伤科杂志,2017,25(12):40-44.
　JIANG Zehua CHENG Zhaojun FANG Zhao WAN Jun ZHANG Xueli.Effect of C7 Spinous Process on Axial Symptoms in Expansive Open-door Laminoplasty[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2017,25(12):40-44.
点击复制

C7棘突在颈椎后路椎管扩大成形术中对轴性症状的影响()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第25卷
期数:
2017年12期
页码:
40-44
栏目:
临床论著
出版日期:
2017-12-15

文章信息/Info

Title:
Effect of C7 Spinous Process on Axial Symptoms in Expansive Open-door Laminoplasty
文章编号:
1005-0205(2017)12-0040-05
作者:
江泽华1 程招军2 方钊1 万军1 张学利1△
1天津市人民医院(天津,300121) 2天津中医药大学研究生院 △通信作者 E-mail:zxl spine@163.com
Author(s):
JIANG Zehua1 CHENG Zhaojun2 FANG Zhao1 WAN Jun1 ZHANG Xueli1△
1Tianjin Union Medical Center, Tianjin 300121, China; 2Graduate School of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
关键词:
颈椎曲度;  颈后路单开门椎管成形术;  轴性症状
Keywords:
Keywords: cervical curvature;  expansive open-door laminoplasty;  axial symptoms
分类号:
R681.5
文献标志码:
A
摘要:
目的:通过对比分析两种不同颈后路手术方法治疗脊髓型颈椎病的临床疗效,从而探讨C7棘突在颈椎后路椎管扩大成形术中对其轴性症状的影响。方法:回顾性分析本科同一手术组2013年9月至2016年10月治疗的67例脊髓型颈椎病的患者的相关资料。按照手术方式的不同分为两组:经颈后路C3～C6单开门椎管扩大成形术组(A组)和经颈后路C3～C7单开门椎管扩大成形术组(B组)。其中A组32例,B组35例。分别记录手术时间、出血量、术前以及术后2周、2个月、6个月,12个月的轴性症状评分、JOA评分、VAS评分及颈椎曲度指数(Cervical Curvature Index,CCI)。结果:共有67例患者入组。其中男性36例,女性31例。年龄在41～70岁,平均年龄(54±3.6)岁,病程3个月～10年,平均(3.4±0.9)年,其中A组32例,B组35例,两组患者的基本资料比较差异均无统计学意义(P>0.05)。A组与B组在不同时间段的JOA评分差异无统计学意义(P>0.05),但两组JOA评分在不断增加。所有67例患者术后均出现不同程度的颈肩疼痛,随访结果显示由于采取不同的措施(治疗、理疗或未处理)有23例患者在术后颈肩疼痛,麻木僵硬,持续时间长,即为出现术后轴性症状。其中A组7例,B组13例。两组的轴性症状的发生率分别为21.88%和37.14%,A组与B组相比,差异无统计学意义(χ2=1.85,P>0.05)。A和B两组术前颈椎曲度指数在术前、术后2周、术后2个月、术后6个月四个时间段中比较,差异无统计学意义(P>0.05),而在术后12个月颈椎曲度指数差异有统计学意义(t=2.141,P=0.036)。结论:两组方法均能明显改善患者术后的神经功能,但选择性颈后路C3～C6单开门椎管成形术较之传统的颈后路C3～C7单开门手术能明显减少患者术后轴性症状的发生且更有利于术后颈椎曲度的维持。
Abstract:
Abstract Objective:To compare the curative effect of C7 spinous process on cervical spondylolisthesis in the treatment of cervical spondylotic myelopathy by comparing the two different posterior approach for cervical spondylotic myelopathy. Methods: We retrospectively analyzed the data of 67 patients with cervical spondylotic myelopathy who underwent surgery from September 2013 to October 2016 in the same operation group. The patients were divided into group A(C3～C6 posterior cervical open-door expansion)and group B(C3～C7 posterior cervical open-door expansion), including 32 cases in group A and 35 cases in group B. The operation time, blood loss, axial symptom scores 2 weeks before operation and 2 weeks, 2 months, 6 months and 12 months after operation, JOA score, VAS score and CCI(cervical curvature index)were recorded. Results: A total of 67 patients were enrolled, including 36 males and 31 females. The age ranged from 41 to 70 years, with an average age of(54.0±3.6)years. The course of disease ranged from 3 months to 10 years, with an average of(3.4±0.9)years. There were 32 cases in group A and 35 cases in group B, and the basic data of the two groups were not statistically significant. There was no significant difference in JOA scores between group A and group B at different time periods, but the JOA scores were increasing. All 67 patients had varying degrees of neck and shoulder pain, and the follow-up results showed that 23 patients had severe long-term neck pain, and numbness due to different measures(treatment, physiotherapy or untreated), that is, the presence of postoperative axial symptoms, including 7 cases in group A and 13 cases in group B. The incidence of axial symptoms was 21.88% and 37.14% respectively and there was no significant difference between group A and group B(χ2=1.85,P>0.05).There was no significant difference in the cervical curvature index between group A and group B before operation, 2 weeks after operation, 2 months after operation and 6 months after operation, but there was statistically significant difference 12 months after operation(t=2.141,P=0.036). Conclusion: The two methods can significantly improve the post operative neurological function of patients, but the C3～C6 posterior cervical open-door expansion compared with the traditional C3～C7 posterior cervical open-door expansion can significantly reduce the postoperative axial symptoms and more beneficial to the maintenance of postoperative cervical curvature.

参考文献/References:

[1] 董庆磊,闫景龙.颈椎后路减压术后轴性症状的研究进展[J].实用骨科杂志,2017,23(7):626-629.
[2] 福嘉欣,江毅.颈椎后路单开门椎管扩大成形术后相关并发症的研究进展[J].脊柱外科杂志,2016,14(1):58-61.
[3] 王辉,丁文元,马雷,等.颈椎术后轴性症状[J].颈腰痛杂志,2014,35(2):146-149.
[4] 谢水清,孙天威,田融,等.脊髓型颈椎病单开门椎板成形术后轴性症状的危险因素分析[J].中国修复重建外科杂志,2014,28(5):620-624.
[5] 刘晓伟,陈德玉,王波,等.C3～C7与C3～C6节段单开门椎管扩大成形术后轴性痛的差异[J].中国脊柱脊髓杂志,2012,22(11):989-993.
[6] Ono A,Tonosaki Y,Yokoyama T,et al.Surgical anatomy of the nuchal muscles in the posterior cervicothoracic junction:significance of the preservation of the C7 spinous process in cervical laminoplasty[J].Spine(Phila Pa 1976),2008,33(11):E349-E354.
[7] Li H,Dai LY.A systematic review of complications in cervical spine surgery for ossification of the posterior longitudinal ligament[J].Spine J,2011,11(11):1049-1057.
[8] Ohnari H,Sasai K,Akagi S,et al.Investigation of axial symptoms after cervical laminoplasty,using questionnaire survey[J].Spine J,2006,6(3):221-227.
[9] 牛硕,孙宇.系统性回顾改良颈椎椎管扩大椎板成形术的疗效及其对轴性症状的影响[J].中国脊柱脊髓杂志,2012,22(1):72-76.
[10] 张黎龙,程招军,崔子健,等.MRI测量脊髓型颈椎病患者矢状位参数相关性分析[J].中国修复重建外科杂志,2017,31(4):451-454.
[11] Shimizu K,Nakamura M,Nishikawa Y,et al.Spinal kyphosis causes demyelination and neuronal loss in the spinal cord:a new model of kyphotic deformity using juvenile Japanese small game fowls[J].Spine(Phila Pa 1976),2005,30(21):2388-2392.
[12] Ogawa Y,Chiba K,Matsumoto M,et al.Postoperative factors affecting neurological recovery after surgery for cervical spondylotic myelopathy[J].J Neurosurg Spine,2006,5(6):483-487.
[13] Yamazaki T,Yanaka K,Sato H,et al.Cervical spondylotic myelopathy:surgical results and factors affecting outcome with special reference to age differences[J].Neurosurgery,2003,52(1):122-126.
[14] Tani S,Isoshima A,Nagashima Y,et al.Laminoplasty with preservation of posterior cervical elements:surgical technique[J].Neurosurgery,2002,50(1):97-102.
[15] 王伟,任龙喜,高成杰.保留颈后方韧带复合体重建伸肌附着点单开门椎板成形术治疗颈椎疾患的临床观察[J].中国脊柱脊髓杂志,2008,18(4):253-256.
[16] 李鹏飞,贾楠,王立红,等.颈后路4种手术方式对颈椎曲度及轴性症状的研究[J].河北医科大学学报,2017,38(1):24-28.
[17] 张仁赞,张学利,胡炜,等.EOLP不同椎板固定方法对颈椎曲度及轴性症状的影响[J].重庆医学,2016,45(6):782-786.

更新日期/Last Update: 2017-12-08