目的 探讨颈椎后路双开门椎管成形术后发生轴性症状的危险因素.方法 回顾性分析2005年5月至2011年7月间因多节段颈椎管狭窄症或(和)颈椎后纵韧带骨化症行颈椎后路双开门椎管成形术手术治疗的患者,搜集患者性别、诊断、年龄、术前颈肩痛VAS评分、病程、有无根性症状、内科合并症等术前情况,手术时间、手术方式、术中出血量,术后颈托制动时间、有无C5神经根麻痹症状,术前JOA评分及术后最佳JOA评分(多次随访取最高评分)等相关资料,术前中立位、前屈位、后伸位C2～C7Cobb角并计算整体活动度等影像学资料,观察患者术后轴性症状的发生情况并进行统计分析.结果 146例患者获得随访,随访时间58～134个月,平均为(89.5±18.4)个月.术后发生轴性症状者57例,总发病率为39.0％.除7例在术后6个月内症状缓解外,余50例(占总随访例数的34.25％,下同)的轴性症状均持续至末次随访.35例(23.97％)以僵硬症状为主,22例(18.49％)则表现为疼痛、牵拉、紧绷等症状.36例(24.66％)轴性症状出现在肩背部,10例(6.85％)出现在切口周围,11例(7.53％)同时出现在肩背部及切口周围.单因素Logistic回归分析显示术中出血量(P=0.019,OR (odds ratio)=1.857,95％Cl为1.107-3.116)和术后最佳JOA评分(P=0.008,0R=0.780,95％CI为0.650-0.936)与术后轴性症状的发生明显相关.采用逐步向前法进行多因素Logistic回归分析,显示除术中出血量和术后最佳JOA评分外,还有以下因素同样影响术后轴性症状的发生概率(P＜0.05):诊断、术前年龄、术前后伸位C2～C7Cobb角、手术破坏C7棘突肌肉止点.诊断为后纵韧带骨化症、术前年龄、术前后伸位C2～C7Cobb角是术后出现轴性症状的保护因素,而诊断为多节段颈椎管狭窄症、手术破坏C7棘突肌肉止点是术后出现轴性症状的危险因素.结论 相对年轻、术前后伸位C2～C7Cobb角小、手术破坏C7棘突肌肉止点、术中出血量多、术后最佳JOA评分低、多节段颈椎管狭窄症的患者更容易出现术后轴性症状.%Objective To explore and analyze the risk factors of axial symptoms after posterior cervical laminoplasty.Methods Retrospectively follow up the patients taking posterior cervical laminoplasty in Jishuitan Hospital during May 2005 to July 2011,due to multi-segmental cervical stenosis or (and) cervical ossification of posterior longitudinal ligament.All patients' gender,diagnosis,age,preoperative neck and shoulder pain,VAS score,course of disease,presence or absence of root symptoms,medical complications,operation time,operation method,blood loss,postoperative neck support time,presence or absence of C5 nerve root paralysis,preoperative JOA and postoperative best JOA,preoperative C2-C7 Cobb angle in neutral position,flexion position,post-extension and calculate the activity were collected.Record the process of axial symptoms in details and statistically analysis by SPSS.Results All of 146 patients were followed up for 58-134 months with an average of 89.5±18.4 months.There were 57 cases of axial symptoms,the overall incidence was 39.0％;except for 7 cases with symptom relief in 6 months,the other 50 cases (34.25％ of the total number of follow-up) of the axial symptoms continued by the time of follow-up.35 patients (23.97％) were characterized by stiffness and 22 patients (18.49％) showed pain,traction and tightness.36 patients (24.66％) showed axial symptoms on the shoulder and back,10 (6.85％) appeared around the wound and 11 (7.53％) appeared on both the shoulder and the wound.Univariate logistic regression analysis showed that intraoperative blood loss (P=0.019,odds ratio(OR) 1.857,95％ CI 1.107-3.116) and postoperative best JOA score (P=0.008,0R=0.780,95％ CI:0.650-0.936) significantly affected the occurrence of postoperative axial symptoms.Multifactor Logistic regression analysis was carried out by stepwise forward method.It was found that besides the intraoperative blood loss and postoperative best JOA score,the following factors also affected the incidence of axial symptoms after operation (P＜0.05):diagnosis,preoperative age,the extension of C2-C7 Cobb angle before operation,and the operation destruction of C7 spinous process muscle stops.The diagnosis of ossification of the posterior longitudinal ligament,preoperative age,and the extension of C2-C7 Cobb angle before operation were the protective factors for the axial symptoms,and the diagnosis of multiple segments of the cervical spinal stenosis and the operation destruction of C7 spinous process were the risk factors for the axial symptoms after the operation.Conclusion Younger,less preoperative C2-C7 Cobb extension,the operation destroys the C7 spinous process muscle stop point,more intraoperative blood loss,lower postoperative best JOA score and patients with multi-segment cervical stenosis more are more easily to have axial symptoms after posterior cervical double door laminoplasty.
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