摘要
目的:比较颈椎全椎板减压术和单开门椎管成形术治疗氟骨症性颈椎管狭窄症(flurosis cervical ste-nosis,FCS)的中期随访结果,评价其临床和影像学效果。方法:2000年2月～2003年2月手术治疗97例FCS患者,其中行单开门椎管成形术42例(A组),行全椎板减压术55例(B组)。两组患者均随访至少5年,采用日本整形外科学会(JOA)神经功能评分和庆应大学的颈椎轴性症状评分(axial symptom score,ASS)进行临床效果评价,通过手术前和术后5年颈椎X线平片和MRI检查的比较,对患者术后5年脊髓后移程度、颈椎曲度指数(curviture index,CI)和活动度(range of motion,ROM)的改变进行评价。结果:两组患者术后5年JOA评分均较术前显著提高(P<0.01),A组和B组的JOA评分改善率分别为59%±4%和53%±5%,两组比较无显著性差异(P>0.05);A组的ASS为10.8±0.2分,明显高于B组的9.2±0.5分(P<0.05)。术后5年A组和B组的脊髓后移距离分别为4.7±0.2mm和5.1±0.3mm,两组比较无显著性差异(P>0.05);两组患者术后5年的CI与术前比较均下降,但A组降低程度显著低于B组(P<0.05);两组患者术后5年ROM与术前比较均明显降低(P<0.05),但两组降低程度无显著性差异(P>0.05)。结论:对于FCS患者全椎板减压手术并不能使脊髓获得更大后移,单开门椎管成形术较之全椎板减压术可以更好地保留骨性结构的完整性,从而更好地维持颈椎曲度,降低术后轴性症状的发生率。
Objective：To compare the mid-term results of laminectomy and expansive laminoplasty for the treatment of fluorosis cervical stenosis （FCS） and to explore more valuable procedure.Method：From February 2000 to February 2003 ,a total of 97 cases with FCS and undergoing surgical management were retrospectively reviewed,of which 42 cases were treated by expansive laminoplasty and classified as study group （group A）, fifty-five patients underwent laminectomy were classified as control group （group B）.The clinical results were evaluated by Japanese Orthopaedic Association（JOA） scores and axial symptom score（ASS）,radiologieal findings on T2-weighted MRI were evaluated before operation and at 5 year- follow-up to determine the extent of spinal cord posterior-shifting, the cervical curvature index （CI） and range of motion （ROM）.Result ：The JOA score in both groups at 5 year-follow-up improved significantly compared with that before operaton （P〈0.01）. The improve rate of JOA score in group A and B were 59%±4% and 53%±5% respeetively（P〉0.05）,but the ASS（10.8±0.2） in group A was significantly higher than those（9.2±0.5） in group B（P〈0.05）.Compared with CI and ROM of preoperation, CI and ROM of 5 year postoperatively in both group decreased significantly （P〈 0.05） ,while no difference were noted between 2 groups （P〉0.05）.T2-weighted MRI before and after operation revealed no significant differences with respect to the extent of the spinal cord posterior-shifting between two groups （4.7±0.2mm and 5.1±0.3mm respectively,P〉0.05）.Conclusion：For FCS,it is impossible for laminectomy to give availabale space for spinal cord shifting postoperatively,while expansive laminoplasty is an effective option to reduce the incidence of postoperative axial symptoms as well as preservation of bony structure which act as maitaiming cervical curvature more preferably.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2009年第1期22-26,共5页
Chinese Journal of Spine and Spinal Cord
