文章摘要
李锋,徐勇,熊伟,方忠,廖晖,关邯峰,吴巍,李勇,李晶,阮智.后路经肌间隙保留颈后伸肌群入路的颈椎椎板成形术的技术要点及临床应用.骨科,2019,10(5):412-417
后路经肌间隙保留颈后伸肌群入路的颈椎椎板成形术的技术要点及临床应用
Cervical laminoplasty preserving cervical extensors through posterior paraspinal approach — Technique note and its clinical results
投稿时间:2019-07-17  
DOI:10.3969/j.issn.1674-8573.2019.05.009
中文关键词: 后路经肌间隙保留颈后伸肌群入路  颈椎椎板成形术  轴性症状  脊髓型颈椎病
英文关键词: Posterior paraspinal approach preserving the cervical extensors  Cervical laminoplasty  Axial symptoms  Cervical spondylotic myelopathy
基金项目:
作者单位E-mail
李锋 华中科技大学同济医学院附属同济医院骨科武汉 430030 lifengmd@hust.edu.cn 
徐勇 华中科技大学同济医学院附属同济医院骨科武汉 430030  
熊伟 华中科技大学同济医学院附属同济医院骨科武汉 430030  
方忠 华中科技大学同济医学院附属同济医院骨科武汉 430030  
廖晖 华中科技大学同济医学院附属同济医院骨科武汉 430030  
关邯峰 华中科技大学同济医学院附属同济医院骨科武汉 430030  
吴巍 华中科技大学同济医学院附属同济医院骨科武汉 430030  
李勇 华中科技大学同济医学院附属同济医院骨科武汉 430030  
李晶 华中科技大学同济医学院附属同济医院骨科武汉 430030  
阮智 华中科技大学同济医学院附属同济医院骨科武汉 430030  
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中文摘要:
      目的 探讨一种改良微创入路——后路经肌间隙保留颈后伸肌群入路的颈椎椎板成形术的技术要点及其早期临床应用效果。方法 对2010年11月至2011年11月采用后路经肌间隙保留颈后伸肌群入路治疗的21例病人的临床资料进行分析,其中男14例,女性7例,平均年龄为54.9岁(40~72岁)。记录手术时间、病人术中出血量、术后引流量、住院时间及术后并发症;记录病人手术前后颈椎疼痛视觉模拟量表(visual analogue scale, VAS)、颈椎功能障碍指数(neck disability index, NDI)、健康调查简表(the MOS item short form health survey, SF-36)及日本骨科协会(Japanese Orthopedic Association,JOA)评分,评估手术效果,分析该方法的技术要点。结果 经颈后肌间隙入路可以获得良好的颈椎椎板成形术手术区暴露,手术均顺利完成。平均手术时间为196 min(170~240 min),平均术中出血量为336 ml(150~700 ml),平均术后引流量为160 ml(50~330 ml),平均住院时间为13.2 d(8~19 d)。术后1例伤口出现脂肪液化,处理后好转;无脑脊液漏、伤口感染、下肢深静脉血栓形成等并发症发生,无内植物松动、移位情况;发生C5神经根麻痹1例,轴性症状3例,主要表现为颈肩部疼痛、发紧感,但症状均较轻,不需特殊处理。末次随访时,颈椎VAS评分、NDI评分、SF-36评分及JOA评分与术前相比均明显改善,差异均有统计学意义(P均<0.05),JOA改善优良率为85.7%(18/21)。结论 颈后路经肌间隙保留颈后伸肌群入路行颈椎椎板成形术体现了微创的理念,能最大限度地保留颈后伸肌群及其附属结构的完整性。该入路可在脊髓充分减压、缓解术后神经症状的同时,减轻轴性症状,提高病人生活质量。
英文摘要:
      Objective To introduce a modified cervical laminoplasty which preserving the cervical extensors through posterior paraspinal approach and its clinical results. Methods From November 2010 to November 2011, 21 patients were treated by the modified cervical laminoplasty which preserving the cervical extensors through the natural cleavage plane between the semispinalis capitis and semispinalis cervicis. There were 14 males and 7 females. The age of patients was from 40 to 72 years old (average age of 54.9 years old). The operation time, blood loss, postoperative complications, visual analogue scale (VAS), neck disability index (NDI), the MOS item short form health survey (SF-36) and Japanese Orthopedic Association (JOA) scores were recorded to evaluate the technique and application of the new approach. Results The new approach enabled sufficient exposure of the posterior cervical spine required by the laminoplasty. The operation time was 196 min (mean 170-240 min), and the blood loss was 336 ml (mean, 150-700 ml), the drainage volume was 160 ml in average (50-330 ml), and the days in hospital was 13.2 d in average (8-19 d). There were no severe complications during and after operation except for one case of C5 nerve root palsy and one case of incision fat liquefaction. Three patients suffered from axis symptom in neck and shoulder region, but there was no severe pain and no further therapy was given. Compared with preoperation, there were significant differences in VAS score, NDI score, SF-36 score and JOA score at last follow-up (P<0.05). And the improvement rate of JOA was 85.7% (18/21). Conclusion The posterior paraspinal approach which preserving the cervical extensors minimized the surgical trauma to the paraspinal muscles and represented a new minimally invasive approach to the cervical spine. The technique is well suited for procedures including the laminoplasty, where it allows sufficient spinal cord decompression; moreover, it also diminishes the incidence of postoperative axial neck pain and improve the quality of life for patients.
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