黑川式和改良黑川式双开门椎板成形椎管扩大术治疗颈椎疾病的对比研究

摘要

目的 观察和对比黑川式和改良黑川式双开门椎板成形椎管扩大术治疗颈椎疾病的中远期疗效.方法 回顾性分析2002年1月至2010年12月行颈椎双开门椎板成形椎管扩大术并获随访的172例患者资料,男性126例,女性46例,年龄35 ～ 80岁,平均(57±l9)岁.其中颈椎病106例,颈椎管狭窄症45例,颈椎后纵韧带骨化症21例.其中行黑川式手术69例(传统术式组),行改良黑川式手术103例(改良术式组).两组患者具有可比性,比较两组疗效根据资料不同采用t检验、x2检验和秩和检验.结果 所有患者均获随访,随访时间12～120个月,平均(52±33)个月；其中随访时间≥2年的患者123例,≥5年的患者71例.所有患者末次随访JOA评分均较术前明显改善(t=3.420,P＜0.01),两组术后改善率差异无统计学意义(P＞0.05)；但术后3个月改良术式组患者术后出现轴性症状的比例(3.9％)要明显低于传统术式组(14.5％)(x2 =7.548,P＜0.05).改良术式组术后3个月颈椎椎间活动度下降情况优于传统术式组(27％±6％比19％±4％,Z=6.34,P=0.036＜0.05),中远期随访椎间活动度两组差异无统计学意义.结论 黑川式和改良黑川式双开门椎板成形椎管扩大术临床应用中远期疗效满意.改良黑川式手术因避免颈后部的伸肌组群损伤,可以降低术后轴性症状的发生率.%Objective To observe and compare the medium-long-term efficacy of Kurokawa's and modified Kurokawa's double door laminoplasty for the treatment of cervical disorders.Methods A retrospective analysis was performed to compare the outcomes and complications between two kinds of operations on 172 cases from January 2002 to December 2010,including 106 cases of cervical spondylotic myelopathy,52 cases of cervical stenosis,21 cases of cervical ossification of the posterior longitudinal ligament,Patients were divided into two groups according to two surgical methods:traditional group,including 51 male and 18 female patients,with mean age of (56 ± 18) years (35-76 years) ; modified group,including 75 male and 28 female patients,with mean age of (58 ± 20)years (35-80 years).The two groups were comparable and compared according to different data using t test,x2 test and rank sum test.Results All patients were followed up continuously for (52 ±33)months,123 patients were followed up ≥2 years,71 patients ≥5 years.All patients' Japanese Orthopaedic Association (JOA) score improved significantly at the latest follow-up (t =3.420,P ＜ 0.01) ; no significant difference between the patients'JOA score improvement rate of two groups.The postoperative incidence rate of axial symptoms in patients of modified group (3.9％) was significantly lower than the traditional group (14.5％) (x2 =7.548,P ＜0.05),and cervical intervertebral activity decreased in the modified group was better than the traditional group in the first 3 months postoperatively (27％ ±6％ vs.19％ ±4％,Z =6.34,P ＜0.05),but during the medium-long-term follow-up,no significant difference in the cervical intervertebral activity decreased between two groups.Conclusions Medium-long-term efficacy of Kurokawa' s and modified Kurokawa' s double door laminoplasty is satisfied and reliable.Avoiding damaging of semispinalis cervicis insertion in spinous process of C2,the modified operation method can protect the extensor group of the neck muscle and reduce the incidence of postoperative axial symptoms better.