• 天津醫(yī)科大學(xué) 天津市人民醫(yī)院脊柱外科（天津，300070）;

目的探討頸后路單開門椎管成形術(shù)與全椎板減壓側(cè)塊螺釘植骨融合內(nèi)固定術(shù)治療脊髓型頸椎病的臨床療效。 方法2006年9月－2009 年9月，對143例多節(jié)段（≥3個）脊髓型頸椎病患者分別采用頸后路單開門擴大椎管成形術(shù)（A組，87例）及全椎板減壓側(cè)塊螺釘植骨融合內(nèi)固定術(shù)（B組，56例）治療，兩組患者性別、年齡、病程、病變分型、病變節(jié)段等一般資料比較差異均無統(tǒng)計學(xué)意義（P  gt; 0.05），具有可比性。隨訪觀察并比較兩組患者手術(shù)時間、術(shù)中出血量、術(shù)后神經(jīng)功能恢復(fù)[采用日本骨科協(xié)會（JOA）17 分評分法]及手術(shù)并發(fā)癥發(fā)生情況，并對兩組患者手術(shù)前后頸椎曲率指數(shù)（cervical curvature index，CCI）、頸椎活動度（range of motion，ROM）及頸肩部疼痛[采用疼痛視覺模擬評分（VAS）及頸椎功能障礙指數(shù)量表（NDI）評分]等指標(biāo)進行評估。 結(jié)果兩組患者手術(shù)時間和術(shù)中出血量比較差異均無統(tǒng)計學(xué)意義（P  gt; 0.05）。兩組患者均獲隨訪，隨訪時間18～30個月，平均24個月。A、B組術(shù)后分別有4例（4.60%）和5例（8.93%）出現(xiàn)C5神經(jīng)根麻痹癥狀，比較差異無統(tǒng)計學(xué)意義（χ2=0.475，P=0.482）。兩組術(shù)后均無深部感染、假關(guān)節(jié)形成及螺釘松動需再手術(shù)等并發(fā)癥發(fā)生。A組患者術(shù)后均無椎板再關(guān)門發(fā)生；B組患者末次隨訪時無螺釘脫出、斷裂及繼發(fā)神經(jīng)損傷等發(fā)生。末次隨訪時A、B組分別有35例（40.23%）和11例（19.64%）有頸部軸性癥狀，比較差異有統(tǒng)計學(xué)意義（χ2=6.612，P=0.009）。兩組患者術(shù)前JOA評分、CCI、頸椎ROM及VAS評分比較差異均無統(tǒng)計學(xué)意義（P  gt; 0.05）；末次隨訪時兩組JOA評分、頸椎ROM、VAS評分及A組CCI均較術(shù)前有顯著改善（P  lt; 0.05）。末次隨訪時，A、B組間JOA評分及改善率、VAS評分比較差異均無統(tǒng)計學(xué)意義（P  gt; 0.05）；A組ROM大于B組，CCI小于B組，差異有統(tǒng)計學(xué)意義（P  lt; 0.05）；末次隨訪時NDI評分，A組在疼痛程度、上舉能力、工作、駕車、反應(yīng)及總分方面均顯著優(yōu)于B組（P  lt; 0.05）。 結(jié)論兩種手術(shù)方式在術(shù)后神經(jīng)功能改善率上無明顯差異，全椎板減壓植骨融合內(nèi)固定術(shù)能有效緩解術(shù)前疼痛，但頸椎活動度降低較大；單開門椎管成形術(shù)并發(fā)癥較少，近期療效滿意。

引用本文： 張杭,孫天威,盧守亮,李清江,Sandip Kumar Yadav. 單開門椎管成形術(shù)與全椎板減壓融合內(nèi)固定術(shù)治療脊髓型頸椎病的臨床療效比較. 中國修復(fù)重建外科雜志, 2012, 26(10): 1191-1196. doi: 復(fù)制

1. Houten JK, Cooper PR. Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery, 2003, 52(5): 1081-1088.
2. Heller JG, Edwards CC II, Murakami H, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine (Phila Pa 1976), 2001, 26(12): 1330-1336.
3. Highsmith JM, Dhall SS, Haid RW Jr, et al. Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion. J Neurosurg Spine, 2011, 14(5): 619-625.
4. Manzano GR, Casella G, Wang MY, et al. A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy. Neurosurgery, 2012, 70(2): 264-277.
5. 孫天威, 張杭, 盧守亮, 等. 頸椎單開門椎管擴大椎板成形術(shù)后鉸鏈側(cè)C5神經(jīng)根麻痹與不同椎板開門角度的臨床分析. 中國修復(fù)重建外科雜志, 2011, 25(11): 1285-1289.
6. Magerl F, Seemann PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation//Kehr P, Weidner A. Cervical Spine. New York: Springer-Verlag, 1987: 322-327.
7. Takeshita K, Murakami M, Kobayashi A, et al. Relationship between cervical curvature index (Ishihara) and cervical spine angle (C2-7). J Orthop Sci, 2001, 6(3): 223-236.
8. Barrett I, Justin H, Joon L, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy. Clin Orthop Relat Res, 2011, 469(3): 688-695.
9. Chiba K, Ogawa Y, Ishii K, et al. Long-term results of expansive open-door laminoplasty for cervical myelopathy—average 14-year follow-up study. Spine (Phila Pa 1976), 2006, 31(26): 2998-3005.
10. Mitsunage LK, Klineberg EO, Gupta MC. Laminoplasty techniques for the treatment of multilevel cervical stenosis. Adv Orthop, 2012, 2012: 307916.
11. Iwasaki M, Okuda SY, Miyauchi A, et al. Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 1: Clinical results and limitations of laminoplasty. Spine (Phila Pa 1976), 2007, 32(6): 647-653.
12. Yamazaki A, Homma T, Uchiyama S, et al. Morphologic limitations of posterior decompression by midsagittal splitting method for myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine. Spine (Phila Pa 1976), 1999, 24(1): 32-34.
13. Hatta Y, Shiraishi T, Hase H, et al. Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy? Spine (Phila Pa 1976), 2005, 30(21): 2414-2419.
14. Sakaura H, Hosono N, Mukai Y, et al. Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation: a comparative study of laminoplasty and anterior spinal fusion. Spine (Phila Pa 1976), 2005, 30(7): 756-759.
15. Hosono N, Sakaura H, Mukai Y, et al. The source of axial pain after cervical laminoplasty-C7 is more crucial than deep extensor muscles. Spine (Phila Pa 1976), 2007, 32(26): 2985-2988.
16. Roy-Camile R, Saillant G, Mazel C. Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plate and screw//Cervical Spine Research Society. The Cervical Spine. 2nd ed. Philadelphia Pa: JB Lippincott, 1989: 390-403.
17. Coe JD, Warden KE, Sutterlin CE, et al. Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine (Phila Pa 1976), 1989, 14(10): 1122-1131.
18. Nassr A, Eck JC, Ponnappan RK, et al. The incidence of C5 Palsy after multilevel cervical decompression procedures: A review of 750 consecutive cases. Spine (Phila Pa 1976), 2012, 37(3): 174-178.
19. Imagama S, Matsuyama Y, Yukawa Y, et al. C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg (Br), 2010, 92(3): 393-400.
20. Kaiser MG , Mummaneni PV, Matz PG, et al. Radiographic assessment of cervical subaxial fusion. J Neurosurg Spine, 2009, 11(2): 221-227.
21. 阮狄克. 頸椎融合加速相鄰節(jié)段退變: 真實還是虛構(gòu)？中國脊柱脊髓雜志, 2011, 21(1): 6-7.
22. 王義生. 脊柱融合術(shù)與非融合術(shù)不是相互替代而是互補？中國脊柱脊髓雜志, 2011, 21(1): 7-8.
23. Wang MY, Green BA, Vitarbo E, et al. Adjacent segment disease: an uncommon complication after cervical expansile laminoplasty: case report. Neurosurgery, 2003, 53(3): 770-773.
24. Huang RC, Girardi FP, Poynton AR, et al. Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft. J Spinal Disord Tech, 2003, 16(2): 123-129.
25. Takeuchi K, Yokoyama T, Aburakawa S, et al. Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-C7 laminoplasty: a modified laminoplasty preserving the semispinalis cervicis inserted into axis. Spine (Phila Pa 1976), 2005, 30(22): 2544-2549.
26. Takeuchi K, Yokoyama T, Ono A, et al. Cervical range of motion and alignment after laminoplasty preserving or reattaching the semispinalis cervicis inserted into axis. J Spinal Disord Tech, 2007, 20(8): 571-576.
  1. 1. Houten JK, Cooper PR. Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery, 2003, 52(5): 1081-1088.
  2. 2. Heller JG, Edwards CC II, Murakami H, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine (Phila Pa 1976), 2001, 26(12): 1330-1336.
  3. 3. Highsmith JM, Dhall SS, Haid RW Jr, et al. Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion. J Neurosurg Spine, 2011, 14(5): 619-625.
  4. 4. Manzano GR, Casella G, Wang MY, et al. A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy. Neurosurgery, 2012, 70(2): 264-277.
  5. 5. 孫天威, 張杭, 盧守亮, 等. 頸椎單開門椎管擴大椎板成形術(shù)后鉸鏈側(cè)C5神經(jīng)根麻痹與不同椎板開門角度的臨床分析. 中國修復(fù)重建外科雜志, 2011, 25(11): 1285-1289.
  6. 6. Magerl F, Seemann PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation//Kehr P, Weidner A. Cervical Spine. New York: Springer-Verlag, 1987: 322-327.
  7. 7. Takeshita K, Murakami M, Kobayashi A, et al. Relationship between cervical curvature index (Ishihara) and cervical spine angle (C2-7). J Orthop Sci, 2001, 6(3): 223-236.
  8. 8. Barrett I, Justin H, Joon L, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy. Clin Orthop Relat Res, 2011, 469(3): 688-695.
  9. 9. Chiba K, Ogawa Y, Ishii K, et al. Long-term results of expansive open-door laminoplasty for cervical myelopathy—average 14-year follow-up study. Spine (Phila Pa 1976), 2006, 31(26): 2998-3005.
  10. 10. Mitsunage LK, Klineberg EO, Gupta MC. Laminoplasty techniques for the treatment of multilevel cervical stenosis. Adv Orthop, 2012, 2012: 307916.
  11. 11. Iwasaki M, Okuda SY, Miyauchi A, et al. Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 1: Clinical results and limitations of laminoplasty. Spine (Phila Pa 1976), 2007, 32(6): 647-653.
  12. 12. Yamazaki A, Homma T, Uchiyama S, et al. Morphologic limitations of posterior decompression by midsagittal splitting method for myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine. Spine (Phila Pa 1976), 1999, 24(1): 32-34.
  13. 13. Hatta Y, Shiraishi T, Hase H, et al. Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy? Spine (Phila Pa 1976), 2005, 30(21): 2414-2419.
  14. 14. Sakaura H, Hosono N, Mukai Y, et al. Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation: a comparative study of laminoplasty and anterior spinal fusion. Spine (Phila Pa 1976), 2005, 30(7): 756-759.
  15. 15. Hosono N, Sakaura H, Mukai Y, et al. The source of axial pain after cervical laminoplasty-C7 is more crucial than deep extensor muscles. Spine (Phila Pa 1976), 2007, 32(26): 2985-2988.
  16. 16. Roy-Camile R, Saillant G, Mazel C. Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plate and screw//Cervical Spine Research Society. The Cervical Spine. 2nd ed. Philadelphia Pa: JB Lippincott, 1989: 390-403.
  17. 17. Coe JD, Warden KE, Sutterlin CE, et al. Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine (Phila Pa 1976), 1989, 14(10): 1122-1131.
  18. 18. Nassr A, Eck JC, Ponnappan RK, et al. The incidence of C5 Palsy after multilevel cervical decompression procedures: A review of 750 consecutive cases. Spine (Phila Pa 1976), 2012, 37(3): 174-178.
  19. 19. Imagama S, Matsuyama Y, Yukawa Y, et al. C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg (Br), 2010, 92(3): 393-400.
  20. 20. Kaiser MG , Mummaneni PV, Matz PG, et al. Radiographic assessment of cervical subaxial fusion. J Neurosurg Spine, 2009, 11(2): 221-227.
  21. 21. 阮狄克. 頸椎融合加速相鄰節(jié)段退變: 真實還是虛構(gòu)？中國脊柱脊髓雜志, 2011, 21(1): 6-7.
  22. 22. 王義生. 脊柱融合術(shù)與非融合術(shù)不是相互替代而是互補？中國脊柱脊髓雜志, 2011, 21(1): 7-8.
  23. 23. Wang MY, Green BA, Vitarbo E, et al. Adjacent segment disease: an uncommon complication after cervical expansile laminoplasty: case report. Neurosurgery, 2003, 53(3): 770-773.
  24. 24. Huang RC, Girardi FP, Poynton AR, et al. Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft. J Spinal Disord Tech, 2003, 16(2): 123-129.
  25. 25. Takeuchi K, Yokoyama T, Aburakawa S, et al. Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-C7 laminoplasty: a modified laminoplasty preserving the semispinalis cervicis inserted into axis. Spine (Phila Pa 1976), 2005, 30(22): 2544-2549.
  26. 26. Takeuchi K, Yokoyama T, Ono A, et al. Cervical range of motion and alignment after laminoplasty preserving or reattaching the semispinalis cervicis inserted into axis. J Spinal Disord Tech, 2007, 20(8): 571-576.