CAJ | 학술논문

目的：比较单开门椎管扩大椎板成形术治疗脊髓型脊椎病和后纵韧带骨化症的疗效。方法选择2005年1月至2010年12月在苏州大学附属第一医院行open-door ELAP手术并获得完整随访的患者71例，手术开门减压节段均为C3~C7。其中21例是后纵韧带骨化症（A组），另50例是脊髓型颈椎病（B组）。记录手术时间、术中出血量、术后轴性症状发生率，C5神经根麻痹及JOA(17分法)评分，在X线片测量颈椎活动度，在末次随访时颈椎CT片上测量椎板掀开角度，对两组进行比较。结果 A组随访13~95个月，平均（46.5±35.8）个月；B组随访13~96个月，平均（47.7±36.4）个月。两组在手术时间、术中出血量、轴性症状发生率、C5神经根麻痹以及术前JOA评分均无统计学差异(P>0.05)。A组和B组术后随访时JOA评分较术前均有不同程度的改善，但A组改善率要低于B组(P<0.05)。影像学资料显示两组患者术后活动度都有所丧失，但两组患者之间无统计学差异（P>0.05）。两组患者末次随访时颈椎CT测量椎板掀开的角度分别为A组（38.04±4.76）°和B组（37.48±4.35）°，两组间比较无统计学差异（P>0.05）。结论单开门椎管扩大椎板成形术可以有效地治疗脊髓型颈椎病和后纵韧带骨化症，但是后纵韧带骨化症患者脊髓功能的恢复低于脊髓型颈椎病患者。
목적：비교단개문추관확대추판성형술치료척수형척추병화후종인대골화증적료효。방법선택2005년1월지2010년12월재소주대학부속제일의원행open-door ELAP수술병획득완정수방적환자71례，수술개문감압절단균위C3~C7。기중21례시후종인대골화증（A조），령50례시척수형경추병（B조）。기록수술시간、술중출혈량、술후축성증상발생솔，C5신경근마비급JOA(17분법)평분，재X선편측량경추활동도，재말차수방시경추CT편상측량추판흔개각도，대량조진행비교。결과 A조수방13~95개월，평균（46.5±35.8）개월；B조수방13~96개월，평균（47.7±36.4）개월。량조재수술시간、술중출혈량、축성증상발생솔、C5신경근마비이급술전JOA평분균무통계학차이(P>0.05)。A조화B조술후수방시JOA평분교술전균유불동정도적개선，단A조개선솔요저우B조(P<0.05)。영상학자료현시량조환자술후활동도도유소상실，단량조환자지간무통계학차이（P>0.05）。량조환자말차수방시경추CT측량추판흔개적각도분별위A조（38.04±4.76）°화B조（37.48±4.35）°，량조간비교무통계학차이（P>0.05）。결론단개문추관확대추판성형술가이유효지치료척수형경추병화후종인대골화증，단시후종인대골화증환자척수공능적회복저우척수형경추병환자。
Objective To compare the clinical efficacy of cervical expansive open-door laminoplasty (open-door ELAP) for multi-segment cervical spondylotic myelopathy and ossification of posterior longitudinal ligament. Method From January 2005 to December 2010, a total of 71 cases underwent open-door ELAP and were followed up well in the first affiliated hospital of soochow university hospital. The range of decompression segments includes C3-C7 in all patients. Twenty-one patients were diagnosed as ossification of posterior longitudinal ligament (group A). Fifty patients were diagnosed as multi-segment cervical spondylotic myelopathy (group B). The operation time, blood loss, JOA scores and incidence of axial symptoms were recorded. Preoperative and postoperative range of motion (ROM) in the cervical spine was measured on cervical radiographs. Angle of the opened laminae was measured according to CT during the period of last follow-up. Result Time of follow-up ranged 13-95 months, mean (46.5±35.8) months in group A and 13-96 months, mean (47.7±36.4) months in group B. No statistical difference was found in the mean operation time, blood loss, incidence of significant axial symptoms and C5 palsy, and preoperative JOA scores between the two groups (P>0.05). Postoperative JOA scores were improved in two groups without significant difference between two groups (P>0.05). However, the recovery rate of JOA scores in group A was significant lower than that in group B (P<0.05). Radiographically, both groups lost extension range of motion (ROM) following laminoplasty, but this change was not statistically significant (P>0.05). The angle of the opened laminae was (38.04±4.76)° in the group A and (37.48±4.35)° in the group B, showing no statistically significant difference (P>0.05). Conclusion Laminoplasty is an effective procedure for the treatment of Patients due to either multi-segment cervical spondylotic myelopathy or ossification of posterior longitudinal ligament. However, recovery of neurological function of patients with ossification of posterior longitudinal ligament was less than that of patients with multi-segment cervical spondylotic myelopathy.