| 王占超,吴晓东,王新伟,袁文.肌间隙入路与传统后路单开门成形术治疗多节段颈椎退行性疾病的临床疗效[J].脊柱外科杂志,2018,16(1):35-40. |
肌间隙入路与传统后路单开门成形术治疗多节段颈椎退行性疾病的临床疗效  点此下载全文 (Fulltext) |
| 王占超 吴晓东 王新伟 袁文 |
| 第二军医大学附属长征医院骨科, 上海 200003 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2018.01.008 |
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| 摘要： |
| 目的 比较肌间隙入路与传统后路单开门成形术治疗多节段颈椎退行性疾病的临床疗效。方法 2016年3月-2016年8月，本院收治40例多节段颈椎退行性疾病患者，其中多节段脊髓型颈椎病（MCSM）伴颈椎椎管狭窄症18例，颈椎后纵韧带骨化症（OPLL）22例；均采用后路单开门椎管扩大椎板成形术治疗。患者随机平均分为2组：A组采取传统门轴侧肌肉椎板剥离入路方式，B组采取改良的门轴侧经多裂肌间隙入路。记录2组患者的住院时间、手术时间、术中出血量、术后引流量，手术前后日本骨科学会（JOA）评分、疼痛视觉模拟量表（VAS）评分、颈椎功能障碍指数（NDI）、椎管矢状径以及术后门轴侧组织液渗出面积，并进行比较。结果 所有患者均手术顺利，无切口感染、脑脊液漏等情况发生，手术切口均一期愈合。2组患者住院时间、术后JOA评分、术后椎管矢状径差异均无统计学意义（P > 0.05）；2组间手术时间、术中出血量、术后引流量、术后VAS评分、术后NDI、门轴侧渗出液面积差异有统计学意义（P < 0.05），B组优于A组。结论 颈椎后路单开门椎管扩大椎板成形术治疗MCSM伴椎管狭窄及多节段颈椎OPLL具有良好的疗效，经多裂肌间隙入路与传统肌肉骨膜下剥离入路相比不会增加手术并发症的发生，且在手术时间、术中出血量、VAS评分及NDI改善等方面具有一定优势，值得临床推广应用。 |
| 关键词：颈椎 颈椎病 骨化,后纵韧带 减压术,外科 |
| Clinical effect of spatium intermusculare approach and conventional posterior approach single open-door laminoplasty in treatment of multi-segmental cervical degenerative disease Fulltext |
| WANG Zhan-chao WU Xiao-dong WANG Xin-wei YUAN Wen |
| Department of Orthopaedics, Changzheng Hospital, Secondary Military Medical University, Shanghai 200003, China |
| Fund Project: |
| Abstract: |
| Objective To compare the clinical effects of spatium intermusculare approach and conventional posterior approach single open-door laminoplasty in treatment of multi-segmental cervical degenerative disease.Methods From March 2016 to August 2016,40 patients with multi-segmental cervical degenerative disease,including multi-segmental cervical spondylotic myelopathy(MCSM) with cervical stenosis in 18,cervical ossification of the posterior longitudinal ligament(OPLL) in 22,were treated with posterior single open-door laminoplasty. Patients were randomly divided into 2 groups according to the chronological order:traditional lamina and muscle dissection approach(group A) in door-shaft side and modified intermusculare space of multifidus muscles approach(group B) in door-shaft side. The length of stay,operation time,intraoperative blood loss,drainage,pre-and post-operative Japanese Orthopaedic Association(JOA) score,visual analogue scale(VAS) score,neck disability index(NDI),sagittal diameter of the spinal canal and postoperative door-shaft side tissue fluid leakage area were recorded and compared between the 2 groups.Results All patients were operated successfully without incision infection,cerebrospinal fluid leakage,and the incisions healed primarily. There was no significant difference in length of stay,postoperative JOA score,postoperative sagittal diameter of the spinal canal between the 2 groups(P > 0.05). The operation time,intraoperative blood loss,drainage,postoperative VAS score,postoperative NDI and postoperative door-shaft side tissue fluid leakage area of group B were all superior to those of group A,and there were statistically significant differences between the 2 groups(P < 0.05).Conclusion Cervical posterior single open-door laminoplasty for the treatment of multi-segmental MCSM with spinal stenosis and multi-segmental cervical OPLL has a good rapeutic effect. Compared with conventional posterior approach,intermusculare space approach does not increase the incidence of surgical complications,and has certain advantages in terms of operation time,intraoperative blood loss,VAS score and NDI improvement,thus being worthy of wider clinical application. |
| Keywords:Cervical vertebrae Cervical spondylosis Ossification of posterior longitudinal ligament Decompression,surgical |
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