颈后路单开门椎管扩大成形术全钛板与交替钛板、缝线固定治疗颈椎病的对比研究

doi:10.19723/j.issn.1671-167X.2019.01.032

摘要/Abstract

摘要：

目的:回顾性比较颈后路单开门椎管扩大成形术所有手术节段使用钛板固定和交替使用钛板、缝线固定两种术式的临床和影像学结果。方法:共入组67例患者,其中交替使用钛板、缝线固定组(A组)33例,所有节段使用钛板固定组(B组)34例。比较两组的基础临床数据和影像学资料,如椎管前后径(anteroposterior diameter,APD)、颈椎曲率指数(cervical curvature index,CCI)和开门角。结果:(1)A、B两组间在手术时间、术中出血量、并发症率、术后住院时间、术前和末次随访时的视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopedic Association,JOA)评分及JOA评分改善率上差异均无统计学意义(P>0.05)。(2)A、B两组间术前、术后和末次随访时的CCI、APD差异也无统计学意义(P>0.05)。术后B组C4、C6节段的开门角大于A组,差异具有统计学意义(P<0.05),而C3、C5、C7节段的开门角两组间差异无统计学意义(P>0.05);末次随访时两组间各节段的开门角差异无统计学意义(P>0.05)。(3)各组内术前、术后和末次随访时的CCI差异无统计学意义(P>0.05), 术后和末次随访时的开门角差异也无统计学意义(P>0.05),但各组内术后和末次随访时的APD大于术前APD,差异具有统计学意义(P<0.05)。(4)A组住院治疗费用低于B组,差异具有统计学意义(P<0.05)。结论:两种单开门术式的临床效果和并发症率并无明显差异,但交替使用钛板、缝线固定的颈后路单开门椎管扩大成形术能降低医疗花费。

关键词: 颈椎病, 椎板成形术, 治疗结果

Abstract:

Objective: To retrospectively compare the effect of alternate levels miniplate and anchor fixation with the effect of all levels miniplate fixation in expansive open-door cervical laminoplasty (EOLP). Methods: Patients with cervical spondylosis underwent EOLP between July 2015 and June 2016 were included in the study. There were 33 patients in the alternate group (alternate levels miniplate and anchor fixation group) and 34 patients in the miniplate group (all levels miniplate fixation group). Neurological function was evaluated with the Japanese Orthopedic Association (JOA) score and degree of pain was assessed with the visual analogue scale (VAS) score. Basic clinical and surgical data, complication rates and medical costs of the two groups were compared. In addition, radiological examinations were performed pre- and post-operatively and at the final follow-up. Relative imaging data such as anteroposterior diameter (APD), cervical curvature index (CCI) and open angle were collected and compared. Results: (1) The mean follow-up time was 18.6 months in the alternate group and 18.9 months in the miniplate group. There were no significant differences in operation time, intraoperative blood loss, perioperative complication rates, post-operative hospital stays, VAS scores and neurological recovery rates preoperatively and at the final follow-up between the two groups. (2) Additionally, no obvious differences were observed about CCIs and APDs at the three follow-up time points between the two groups. Post-operative open angles at C4 and C6 in the alternate group were significantly smaller than those in the miniplate group. However, there were no significant differences in C3, C5 and C7 open angles between the two groups post-operatively. Notably, no significant differences were detected about the open angles at all levels between the two groups at the final follow-up. (3) When comparing radiologic data at different time points in each group, CCIs and open angles at each level had no significant differences, but APDs after surgery and at the final follow-up were significantly larger than pre-operative APDs. (4) Total costs in the alternate group were significantly lower than those in the miniplate group. Conclusion: The two surgical methods showed almost the same neurological recovery rates and complication rates. However, use of alternate levels miniplate and anchor fixation in EOLP can reduce medical expenses.

Key words: Cervical spondylosis, Laminoplasty, Treatment outcome

中图分类号:

R681.5

杨泽川,刘朝旭,林阳,胡伟华,陈文坚,李锋,曾恒. 颈后路单开门椎管扩大成形术全钛板与交替钛板、缝线固定治疗颈椎病的对比研究[J]. 北京大学学报（医学版）, 2019, 51(1): 187-193.

Ze-chuan YANG,Chao-xu LIU,Yang LIN,Wei-hua HU,Wen-jian CHEN,Feng LI,Heng ZENG. All levels miniplate fixation and a modified hybrid fixation method in expansive open-door cervical laminoplasty: a retrospective comparative study[J]. Journal of Peking University(Health Sciences), 2019, 51(1): 187-193.

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参考文献 25

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Items	Group A (n=33)	Group B (n=34)	P
Age/years	52.1±10.3	54.6±11.2	0.35
Gender (male/female)	23/10	29/5	0.13
Operation time/min	177.5±45.5	191.2±49.1	0.25
Post-operation hospital stay/d	7.9±2.3	8.8±2.0	0.08
Blood loss/mL	471.1±198.1	611.6±416.3	0.19
VAS score
Before surgery	2.0±2.8	1.4±3.0	0.45
Final follow-up	1.5±2.2	1.7±2.4	0.80
JOA score
Before surgery	13.3±3.4	14.5±2.1	0.11
Final follow-up	15.6±3.2	16.1±1.1	0.45
Recovery rate/%	55.6±65.2	44.2±49.2	0.45
Medical cost/yuan	107 707.2±10 915.3	154 489.6±11 920.9	<0.001

Segment	Pre-operation			Post-operation			Final follow-up
Segment	Group A	Group B	P	Group A	Group B	P	Group A	Group B	P
C3	15.2±1.1	15.5±1.4	0.49	23.3±2.4	23.2±2.5	0.89	22.3±1.4	22.1±2.1	0.70
C4	14.7±1.3	14.8±1.4	0.75	22.6±2.3	22.8±2.1	0.61	22.1±1.3	21.9±2.0	0.77
C5	15.1±1.2	15.7±1.5	0.12	24.1±2.1	23.6±2.2	0.42	23.6±1.4	22.5±2.0	0.06
C6	16.2±1.2	16.3±1.5	0.74	24.6±2.2	25.0±2.0	0.54	23.7±1.6	24.1±1.7	0.46
C7	16.3±1.2	17.0±1.7	0.06	25.7±2.6	25.1±2.3	0.39	25.0±2.1	24.5±1.9	0.55

Segment	Post-operation			Final follow-up
Segment	Group A	Group B	P	Group A	Group B	P
C3	30.1±5.7	34.5±6.9	0.06	34.0±4.9	31.8±7.1	0.44
C4	28.4±5.3	35.1±6.4	0.003	31.2±6.0	31.7±7.0	0.87
C5	33.5±4.4	34.9±6.4	0.52	33.8±5.0	31.5±5.9	0.36
C6	29.9±6.3	37.9±6.0	0.001	30.6±5.9	34.8±4.1	0.07
C7	32.3±5.2	37.7±8.5	0.07	33.9±5.3	34.2±6.0	0.91

Segment	Group A			Group B
Segment	Pre-operation	Follow-up	P	Post-operation	Follow-up	P
C3	30.1±5.7	34.0±4.9	0.08	34.5±6.9	31.8±7.1	0.39
C4	28.4±5.3	31.2±6.0	0.20	35.1±6.4	31.7±7.0	0.25
C5	33.5±4.4	33.8±5.0	0.89	34.9±6.4	31.5±5.9	0.21
C6	29.9±6.3	30.6±5.9	0.78	37.9±6.0	34.8±4.1	0.17
C7	32.3±5.2	33.9±5.3	0.09	37.7±8.5	34.2±6.0	0.29

Segment	Group A			Group B
Segment	Pre-operation	Post-operation	Follow-up	Pre-operation	Post-operation	Follow-up
C3	15.2±1.1	23.3±2.4^*	22.3±1.4^*	15.5±1.4	23.2±2.5^*	22.1±2.1^*
C4	14.7±1.3	22.6±2.3^*	22.1±1.3^*	14.8±1.4	22.8±2.1^*	21.9±2.0^*
C5	15.1±1.2	24.1±2.1^*	23.6±1.4^*	15.7±1.5	23.6±2.2^*	22.5±2.0^*
C6	16.2±1.2	24.6±2.2^*	23.7±1.6^*	16.3±1.5	25.0±2.0^*	24.1±1.7^*
C7	16.3±1.2	25.7±2.6^*	25.0±2.1^*	17.0±1.7	25.1±2.3^*	24.5±1.9^*