颈椎后路单开门椎管扩大成形术范围延至寰椎的手术指征探讨_《中国修复重建外科杂志》

作者：

李清江 ^1,2 , 孔清泉 ² , 张立 ³ , 孙天威 ¹ , 李涛 ² , 龚全 ² , 宋跃明 ² , 刘浩 ²

1天津医科大学天津市人民医院脊柱外科（天津，300070）;;
2四川大学华西医院骨科;;
3 北京大学第三医院骨科;

关键词：

单开门椎管扩大成形术椎管减压颈椎管狭窄后纵韧带骨化

DOI：

10.7507/1002-1892.20130266

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目的探讨颈椎后路单开门椎管扩大成形术范围延至寰椎的手术指征。方法筛选2005年9月－2010年1月收治的颈椎C3～7或C2～7单开门椎管扩大成形术后，因C1～4范围内狭窄导致脊髓损害症状不缓解或缓解后再次加重，再手术将减压节段延伸至C1节段的后纵韧带骨化患者，排除因手术本身原因所致的再手术者，共17例作为研究组，并与因颈椎管狭窄症行C2～7减压联合C1后弓切除术患者15例（对照组）进行比较。两组患者性别、年龄、病程等一般资料比较差异均无统计学意义（P gt; 0.05），具有可比性。根据患者影像学资料评估其手术前后颈椎曲度及脊髓受压情况；应用日本骨科协会（JOA）脊髓功能17分评分表和Frankel分级评价患者手术前后神经功能情况；通过Hirabayashi等方法评估术后神经功能改善情况。结果研究组17例患者中，初次行C3～7椎管扩大成形8例，其中3例存在C1、2节段狭窄，脊髓周围脑脊液信号不连续；5例在C2～4节段有最大前后径 gt; 7.0 mm的致压物。初次行C2～7椎管扩大成形术9例，C2～4节段均有最大前后径 gt; 7.0 mm的致压物。17例患者再次手术将减压节段延至C1，术后随访时间35～61个月，平均45.6个月；颈椎曲度情况：术前为颈椎前凸11例、直形颈椎4例、颈椎后凸2例，术后有2例颈椎前凸变为直形颈椎，1例直形颈椎变为后凸；神经改善率优8例，良7例，可2例。对照组术前C2～4节段均有最突出部位前后径 gt; 7.0 mm的致压物；术后随访时间30～58个月，平均38.7个月；颈椎曲度情况：术前为颈椎前凸13例、直形颈椎2例，术后有1 例颈椎前凸变为直形颈椎；神经功能恢复率为优8例，良6例，可1例。术前及末次随访时两组组间比较JOA评分差异均无统计学意义（P gt; 0.05），两组末次随访时JOA 评分均较术前显著改善（P lt; 0.05）。结论对于颈椎后路单开门椎管扩大成形术范围延至寰椎的手术指征，初步提出以下几点：①上颈椎（C1、2）椎管狭窄，判定标准为：C1后弓下缘以上部分脊髓周围脑脊液信号不连续，且椎管实际前后径 lt; 8.0 mm。②C2～4椎体下缘节段存在巨大致压物，最突出部位直径 gt; 7.0 mm，无法通过颈椎前路手术去除致压因素，或前路手术风险性极大时。

引用本文： 李清江,孔清泉,张立,孙天威,李涛,龚全,宋跃明,刘浩. 颈椎后路单开门椎管扩大成形术范围延至寰椎的手术指征探讨. 中国修复重建外科杂志, 2013, 27(10): 1214-1220. doi: 10.7507/1002-1892.20130266 复制

1.	Mitsunage LK, Klineberg EO, Gupta MC. Laminoplasty techniques for the treatment of multilevel cervical stenosis. Adv Orthop, 2012, 2012: 307916.
2.	Hirabayashi K, Miyakawa J, Satomi K, et al. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976), 1981, 6(4): 354-364.
3.	Nolan JP Jr, Sherk HH. Biomechanical evaluation of the extensor musculature of the cervical spine. Spine (Phila Pa 1976), 1988, 13(1): 9-11.
4.	Takeshita K, Peterson ET, Bylski-Austrow D, et al. The nuchal ligament restrains cervical spine flexion. Spine (Phila Pa 1976), 2004, 29(18): E388-393.
5.	Liu J, Ebraheim NA, Sanford CG, et al. Preservation of the spinous process-ligament-muscle complex to prevent kyphotic deformity following laminoplasty. Spine J, 2007, 7(2): 159-164.
6.	Hosono N, Sakaura H, Mukai Y, et al. C3-6 laminoplasty takes over C3-7 laminoplasty with significantly lower incidence of axial neck pain. Eur Spine J, 2006, 15(9): 1375-1379.
7.	Sakaura H, Hosono N, Mukai Y, et al. Preservation of muscles attached to the C2 and C7 spinous processes rather than subaxial deep extensors reduces adverse effects after cervical laminoplasty. Spine (Phila Pa 1976), 2010, 35(16): E782-786.
8.	Sakaura H, Hosono N, Mukai Y, et al. Preservation of the nuchal ligament plays an important role in preventing unfavorable radiologic changes after laminoplasty. J Spinal Disord Tech, 2008, 21(5): 338-343.
9.	Takeuchi K, Yokoyama T, Aburakawa S, et al. Postoperative changes at the lower end of cervical laminoplasty: for preservation of the C7 spinous process in laminoplasty. J Spinal Disord Tech, 2006, 19(6): 402-406.
10.	Takeuchi T, Shono Y. Importance of preserving the C7 spinous process and attached nuchal ligament in French-door laminoplasty to reduce postoperative axial symptoms. Eur Spine J, 2007, 16(9): 1417-1422.
11.	Yasuoka S, Peterson HA, MacCarty CS. Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg, 1982, 57(4): 441-445.
12.	Katsumi Y, Honma T, Nakamura T. Analysis of cervical instability resulting from laminectomies for removal of spinal cord tumor. Spine (Phila Pa 1976), 1989, 14(11): 1171-1176.
13.	Inoue A, Ikata T, Katoh S. Spinal deformity following surgery for spinal cord tumors and tumorous lesions: analysis based on an assessment of the spinal functional curve. Spinal Cord, 1996, 34(9): 536-542.
14.	Steinbok P, Boyd M, Cochrane D. Cervical spinal deformity following craniotomy and upper cervical laminectomy for posterior fossa tumors in children. Childs Nerv Syst, 1989, 5(1): 25-28.
15.	Zhang J, Hirabayashi S, Saiki K, et al. Effectiveness of multiple-level decompression in laminoplasty and simultaneous C1 laminectomy for patients with cervical myelopathy. Eur Spine J, 2006, 15(9): 1367-1374.
16.	Takeshita K, Seichi A, Akune T, et al. Can laminoplasty maintain the cervical alignment even when the C2 lamina is contained? Spine (Phila Pa 1976), 2005, 30(11): 1294-1298.
17.	Kong Q, Zhang L, Liu L, et al. Effect of the decompressive extent on the magnitude of the spinal cord shift after expansive open-door laminoplasty. Spine (Phila Pa 1976), 2011, 36(13): 1030-1036.
18.	Lee JY, Sharan A, Baron EM, et al. Quantitative prediction of spinal cord drift after cervical laminectomy and arthrodesis. Spine (Phila Pa 1976), 2006, 31(16): 1795-1798.
19.	Kawakami M, Tamaki T, Ando M, et al. Relationships between sagittal alignment of the cervical spine and morphology of the spinal cord and clinical outcomes in patients with cervical spondylotic myelopathy treated with expansive laminoplasty. J Spinal Disord Tech, 2002, 15(5): 391-397.
20.	Baba H, Uchida K, Maezawa Y, et al. Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: a magnetic resonance imaging study. J Neurol, 1996, 243(9): 626-632.
21.	Sodeyama T, Goto S, Mochizuki M, et al. Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine (Phila Pa 1976), 1999, 24(15): 1527-1532.

1. Mitsunage LK, Klineberg EO, Gupta MC. Laminoplasty techniques for the treatment of multilevel cervical stenosis. Adv Orthop, 2012, 2012: 307916.
2. Hirabayashi K, Miyakawa J, Satomi K, et al. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976), 1981, 6(4): 354-364.
3. Nolan JP Jr, Sherk HH. Biomechanical evaluation of the extensor musculature of the cervical spine. Spine (Phila Pa 1976), 1988, 13(1): 9-11.
4. Takeshita K, Peterson ET, Bylski-Austrow D, et al. The nuchal ligament restrains cervical spine flexion. Spine (Phila Pa 1976), 2004, 29(18): E388-393.
5. Liu J, Ebraheim NA, Sanford CG, et al. Preservation of the spinous process-ligament-muscle complex to prevent kyphotic deformity following laminoplasty. Spine J, 2007, 7(2): 159-164.
6. Hosono N, Sakaura H, Mukai Y, et al. C3-6 laminoplasty takes over C3-7 laminoplasty with significantly lower incidence of axial neck pain. Eur Spine J, 2006, 15(9): 1375-1379.
7. Sakaura H, Hosono N, Mukai Y, et al. Preservation of muscles attached to the C2 and C7 spinous processes rather than subaxial deep extensors reduces adverse effects after cervical laminoplasty. Spine (Phila Pa 1976), 2010, 35(16): E782-786.
8. Sakaura H, Hosono N, Mukai Y, et al. Preservation of the nuchal ligament plays an important role in preventing unfavorable radiologic changes after laminoplasty. J Spinal Disord Tech, 2008, 21(5): 338-343.
9. Takeuchi K, Yokoyama T, Aburakawa S, et al. Postoperative changes at the lower end of cervical laminoplasty: for preservation of the C7 spinous process in laminoplasty. J Spinal Disord Tech, 2006, 19(6): 402-406.
10. Takeuchi T, Shono Y. Importance of preserving the C7 spinous process and attached nuchal ligament in French-door laminoplasty to reduce postoperative axial symptoms. Eur Spine J, 2007, 16(9): 1417-1422.
11. Yasuoka S, Peterson HA, MacCarty CS. Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg, 1982, 57(4): 441-445.
12. Katsumi Y, Honma T, Nakamura T. Analysis of cervical instability resulting from laminectomies for removal of spinal cord tumor. Spine (Phila Pa 1976), 1989, 14(11): 1171-1176.
13. Inoue A, Ikata T, Katoh S. Spinal deformity following surgery for spinal cord tumors and tumorous lesions: analysis based on an assessment of the spinal functional curve. Spinal Cord, 1996, 34(9): 536-542.
14. Steinbok P, Boyd M, Cochrane D. Cervical spinal deformity following craniotomy and upper cervical laminectomy for posterior fossa tumors in children. Childs Nerv Syst, 1989, 5(1): 25-28.
15. Zhang J, Hirabayashi S, Saiki K, et al. Effectiveness of multiple-level decompression in laminoplasty and simultaneous C1 laminectomy for patients with cervical myelopathy. Eur Spine J, 2006, 15(9): 1367-1374.
16. Takeshita K, Seichi A, Akune T, et al. Can laminoplasty maintain the cervical alignment even when the C2 lamina is contained? Spine (Phila Pa 1976), 2005, 30(11): 1294-1298.
17. Kong Q, Zhang L, Liu L, et al. Effect of the decompressive extent on the magnitude of the spinal cord shift after expansive open-door laminoplasty. Spine (Phila Pa 1976), 2011, 36(13): 1030-1036.
18. Lee JY, Sharan A, Baron EM, et al. Quantitative prediction of spinal cord drift after cervical laminectomy and arthrodesis. Spine (Phila Pa 1976), 2006, 31(16): 1795-1798.
19. Kawakami M, Tamaki T, Ando M, et al. Relationships between sagittal alignment of the cervical spine and morphology of the spinal cord and clinical outcomes in patients with cervical spondylotic myelopathy treated with expansive laminoplasty. J Spinal Disord Tech, 2002, 15(5): 391-397.
20. Baba H, Uchida K, Maezawa Y, et al. Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: a magnetic resonance imaging study. J Neurol, 1996, 243(9): 626-632.
21. Sodeyama T, Goto S, Mochizuki M, et al. Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine (Phila Pa 1976), 1999, 24(15): 1527-1532.

《中国修复重建外科杂志》

颈椎后路单开门椎管扩大成形术范围延至寰椎的手术指征探讨

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《中国修复重建外科杂志》

颈椎后路单开门椎管扩大成形术范围延至寰椎的手术指征探讨

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