保留颈半棘肌肌止椎板成形术临床应用.docVIP

保留颈半棘肌肌止椎板成形术临床应用 　 作者：张为，董玉昌，申勇，丁文元，张标，李宝俊，姚晓光 【关键词】 颈椎管狭窄；,,颈半棘肌;,,矢状序列;,,轴性症状;,,椎板成形术 　　摘 要：［目的］研究确定行颈椎单开门椎板成形术时完整保留C2颈半棘肌肌止是否能有效维持颈椎术后矢状序列，降低术后颈椎轴性症状的发生。［方法］2002年3月~2003年12月，本院行保留颈半棘肌肌止的椎板成形术48例，其中32例获得至少2 a的随访列为试验组，对患者术前、术后的JOA评分、颈椎轴性症状严重程度、颈椎曲度指数、颈椎活动度进行比较评估。［结果］本组患者术前、术后JOA评分分别为（90±29）和（125±31），恢复率（449±269）。手术前、后有明显症状颈椎轴性症状的患者比例分别为468%和187%，差别有统计学意义（P＜005）。手术前后患者颈屈指数、颈椎活动范围等指标无统计学意义差别。［结论］保留颈半棘肌肌止的椎板成形术可以减少对颈椎后伸机理的破坏，有效维持术后颈椎矢状序列减少轴性症状的发生。 关键词：颈椎管狭窄； 颈半棘肌; 矢状序列; 轴性症状; 椎板成形术 Abstract：［Objective］To verify whether or not the modified opendoor laminoplasy preserving semispinalis cervicis insert into axis is effective in preventing postoperative axial symptom and maintaining postoperative cervical sagittal alignment［Method］Since March 2002 to December 2003,fortyeight patients underwent modified opendoor laminoplasy preserving semispinalis cervicis insert into Axis,among them,thirtytwo patients who were followed up for more than 2 years were included in this studyPreoperative and postoperative JOA score,degree of axial symptom,ranges of neck motion,cervical curvature index were recorded and compared［Result］Preoperative and postoperative JOA score was（904±29）and（125±31）respectively,with recovery rate as（449±269）There was significant difference between preoperative evident axil symptom rate（468%）and postoperative evident axil symptom rate（187%）,while no significant difference between preoperative and postoperative ranges of neck motion,cervical curvature index was seen［Conclusion］Modified opendoor laminoplasy is less invasive to the posterior extensor mechanism especially the semispinalis cervicis than conventional opendoor laminoplasyThis new procedure is effective in preventing postoperative morbidities often seen after conventional laminoplasy with adequate decompression of the spinal cord Key words：Stenosis of cervical vetebra canal; Semispinalis cervicis; Axial symptoms; Sagittal alignment; Laminoplasty 颈椎椎板成形术是一项较为成熟的外科技术〔1〕，但术后常常遗留或发生颈肩背部疼痛、僵硬、颈项活动受限等症状。1