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门轴位置对单开门颈椎管成形术效果的影响

Clinical validity of hinge position to expansive semi open-door laminoplasty

摘要:

目的 评价不同门轴位置对于单开门颈椎管成形术(EOLP)临床治疗效果的影响.方法 2006年2月至2007年2月,102名确诊脊髓型颈椎病并行EOLP手术的患者纳入本次随机对照研究.依据随机数字表法57例纳入研究组,门轴位置为侧块内侧缘,较对侧开门的位置宽,设定为宽开门组;另45例纳入对照组,门轴位于椎板外缘和开门位置对称,该组患者设定为窄开门组.随访24个月,对术后临床和影像学的各项指标进行统计分析.结果 术后24个月随访两组间比较:手术时间、出血量、日本骨科学会(JOA)评分增长率、颈椎前突指数、颈椎活动度差异均无统计学意义;两组患者手术后均获得了满意的神经功能改善,但是轴性症状评分和C5神经根麻痹发生率,窄开门组明显低于宽开门组(均P<0.05).结论 手术中适当将门轴位置内移既可以保证手术减压的效果,又可以限制脊髓过度后移,有效避免C5神经根麻痹的发生,降低轴性症状的发生程度.

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abstracts:

Objective To evaluate and compare the efficacy and clinical results of cervical expansive opendoor lamino-plasty(EOLP)with different hinge position. Methods From February 2006 to February 2007, a total of 102 cases with cervical spondylotic myelopathy were assessed in this randomized controlled trial. Fifty-seven patients underwent EOLP with the hinge located at the inner margin of the lateral mass classified as wide-open group. Forty-five cases who underwent EOLP with the hinge positioned at the lamina margin served as narrow-open group. The clinical results and radiological examinations of both groups were evaluated 24 months after surgery. Results There were no significant differences in operation time,bleeding quantity and recovery rate of Japanese Orthopaedic Association (JOA) scores. The incidence of C5 palsy and severity of axial symptoms in the wide-open group were significantly lower than those in the narrowopen group (P < 0.05). There were no significant differences in cervical curvature index and range of motion between the two groups. Conclusions Well-suited and appropriated inwardly shift the hinge could promote clinical outcomes after EOLP, especially decrease the incidence of the C5 palsy and the severity of axial symptom, but it is contraindication for patients with ossification of posterior longitudinal ligment,ossification of ligment flavum and flurosis cervical stenosis.

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作者: 夏英鹏 [1] 张学利 [1] 李辉南 [1] 宋海峰 [1]
第一作者: 夏英鹏
期刊: 《中华外科杂志》2010年48卷16期 1229-1233页 MEDLINEISTICPKUCSCD
分类号: R6
DOI: 10.3760/cma.j.issn.0529-5815.2010.16.008
发布时间: 2010-09-10
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