摘要目的 研究颈椎后路减压单开门椎管扩大成形术联合侧块螺钉固定治疗合并不稳定的多节段脊髓型颈椎病的疗效. 方法 对41例合并节段不稳的多节段颈椎病患者行颈椎后路减压单开门椎管扩大成形侧块螺钉固定术.采用日本骨科协会评分(JOA)判定神经功能,颈椎功能残障指数量表(NDI)评价颈肩轴性痛程度,Ishihara法测定颈椎曲率指数(CCI),在MRI上测量脊髓扩大程度. 结果 平均随访43个月后,患者JOA评分由术前(7.12±0.91)分,改善至末次随访的(14.73±1.12)分(t=35.28,P＜0.001).术前CCI平均为(10.36±1.69),与术后(10.87±2.05)相比无明显变化(t=1.11,P＞0.05).颈椎轴位MRI显示最狭窄处脊髓面积由术前(0.22±0.05) cm2增至术后(0.62±0.09)cm2(t=14.15,P＜0.001).术后NDI为(12.90±3.46)分较术前(24.46±6.61)分,明显缓解(t=15.59,P＜0.001). 结论 颈椎后路减压单开门椎管扩大成形术联合侧块螺钉固定治疗合并不稳的多节段脊髓型颈椎病,能明显改善患者脊髓功能,维持颈椎的曲度.

abstractsObjective To investigate the effectiveness of open-door laminoplasty with lateral mass screw fusion in the treatment of multisegmental cervical spondylotic myelopathy (CSM)with segmental instability.Methods Forty-one patients with multisegmental cervical spondylotic myelopathy combined with instability underwent open-door laminoplasty with lateral mass screw fusion.The JOA(Japanese Orthopaedic Association)scoring system and Neck Disability Index(NDI) were applied to evaluate neurological function and axial neck/shoulder pain before and after surgery,respectively.In addition,the Ishihara method was used to measure the cervical curvature index(CCI),and spinal cord expansion was calculated with MRI.Results After 43 months of postoperative follow-up,there were significant differences in JOA scores[(7.12±0.91) vs.(14.73± 1.12),t =35.28,P＜0.001],areas of the dural sac at the level of maximum stenosis in MRI[(0.22±0.05)]cm2 vs.(0.62±0.09)cm2,t=14.15,P＜0.001],and NDI scores[(24.46±6.61) vs.(12.90±3.46),t=15.59,P ＜ 0.001],compared with those before treatment.However,there were no significant differences in pre-and post-operation CCI[(10.36±1.69) vs.(10.87±2.05),t=1.11,P＞0.05].Conclusions Open-door laminoplasty with lateral mass screw fusion can improve neurological function and maintain the normal cervical curvature.Therefore,it is effective in the treatment of multisegmental cervical spondylotic myelopathy with segmental instability.