CAJ | 학술논문

目的了解第2至第7颈椎(C2～7)椎板成形术对脊髓前间隙(ACS)的影响,并与传统的第3至第7颈椎(C3～7)椎板成形术比较,为合理的向头侧扩大减压范围提供依据.方法对2008年2月至201 1年10月行颈后路单开门椎板成形术57例患者的资料进行回顾性分析.按减压节段的不同分为C3～7组(32例)和C2～7组(25例).比较各组手术前后神经功能、颈肩痛以及颈椎曲度;测量并比较两组患者术后MRI上C2～3至C7 ～T1各节段ACS数值.结果两组患者手术后神经功能均有显著改善,颈肩痛程度及颈椎曲度较术前差异无统计学意义;C3～7组在C2～3及C3～4水平上ACS分别为6.13 mm(95％ CI:5.71 ～6.55)和6.60 mm(95％ CI:6.10 ～7.11),与之相比,C2～7组在C2～3及C3～4水平上ACS分别增加2.5 mm和2.1 mm,两组间差异有统计学意义(P＜0.01);两组在C4～5及以下水平ACS无明显差异.结论与传统的C3～7单开门椎板成形术相比,向头侧扩大减压至C2,可以在C2～3及相邻的C3～4水平获得更大的ACS;当C3～4水平脊髓前方致压物在中矢径＞6.10 mm时,行C3～7减压可能造成该水平脊髓减压不充分,应考虑向头侧扩大减压范围.
목적 료해제2지제7경추(C2～7)추판성형술대척수전간극(ACS)적영향,병여전통적제3지제7경추(C3～7)추판성형술비교,위합리적향두측확대감압범위제공의거.방법 대2008년2월지201 1년10월행경후로단개문추판성형술57례환자적자료진행회고성분석.안감압절단적불동분위C3～7조(32례)화C2～7조(25례).비교각조수술전후신경공능、경견통이급경추곡도;측량병비교량조환자술후MRI상C2～3지C7 ～T1각절단ACS수치.결과 량조환자수술후신경공능균유현저개선,경견통정도급경추곡도교술전차이무통계학의의;C3～7조재C2～3급C3～4수평상ACS분별위6.13 mm(95％ CI:5.71 ～6.55)화6.60 mm(95％ CI:6.10 ～7.11),여지상비,C2～7조재C2～3급C3～4수평상ACS분별증가2.5 mm화2.1 mm,량조간차이유통계학의의(P＜0.01);량조재C4～5급이하수평ACS무명현차이.결론 여전통적C3～7단개문추판성형술상비,향두측확대감압지C2,가이재C2～3급상린적C3～4수평획득경대적ACS;당C3～4수평척수전방치압물재중시경＞6.10 mm시,행C3～7감압가능조성해수평척수감압불충분,응고필향두측확대감압범위.
Objectives To investigate the effect of C2-7 laminoplasty on postoperative anterior cord space (ACS) compared with C3-7 laminoplasty,and to provide evidence for reasonable enlargement of decompression range cephalad.Methods Fifty-seven Patients underwent cervical laminoplasty from February 2008 to October 2011 were studied retrospectively,which were divided into two groups by decompression range:Group C3-7 and Group C2-7.The pre-and post operative JOA scores,VAS scores of neek and shoulder pain,and cervical alignment were compared in each group.The postoperative ACS at each level from C2-3 to C7-T1 measured on MRI were compared between the two groups.Results The postoperative JOA scores increased significantly in both groups.VAS scores and cervical alignment showed no significant difference.ACS at C2-3 and C3-4 was 6.13 mm (95％ CI:5.71-6.55) and 6.60 mm (95％ CI:6.10-7.11) respectively in Group C3-7,which increased 2.5 mm and 2.1 mm respectively in Group C2-7 at the same segment,there was significant difference (P ＜ 0.01).However,there was no significant difference of ACS at C4-5 and any other caudal levels between the two groups.Conclusions Compared with conventional C3-7 laminoplasty,the extensive decompression cephalad to C2 leads to larger ACS at C2-3 and C3-4.When the mid-sagittal diameter of anterior compression is more than 6.10 mm at C3-4,C3-7 laminoplasty may cause insufficient decompression,and enlargement of decompression range cephalad should be considered.