选择性单开门椎板成形术治疗多节段脊髓型颈椎病的疗效

doi:10.11958/20242402

天津医药 ›› 2025, Vol. 53 ›› Issue (7): 719-724.doi: 10.11958/20242402

选择性单开门椎板成形术治疗多节段脊髓型颈椎病的疗效

江泽华¹(), 张伯裕¹, 张洪杰², 崔皓竣¹^,³, 任志帅¹, 于浩¹, 周蒙蒙¹, 朱如森¹^,^△()

1 天津市人民医院，南开大学第一附属医院脊柱外科（邮编300121）
2 德宏州人民医院，昆明医科大学附属德宏医院
3 天津医科大学研究生院

收稿日期:2024-12-27 修回日期:2025-04-24 出版日期:2025-07-15 发布日期:2025-07-21
通讯作者: ^△E-mail：zrsspine@163.com
作者简介:江泽华（1983），男，主治医师，主要从事脊柱脊髓疾病、退行性脊柱疾病方面研究。E-mail：jzhspine@163.com
基金资助:
天津市卫生健康委员会科技项目青年项目(TJWJ2022QN040);云南省英才兴边计划(2023RC006);天津市卫生健康科技项目(TJWJ2024QN045)

Efficacy of selective expansive opendoor laminoplasty in the treatment of multisegmental cervical spondylotic myelopathy

JIANG Zehua¹(), ZHANG Boyu¹, ZHANG Hongjie², CUI Haojun¹^,³, REN Zhishuai¹, YU Hao¹, ZHOU Mengmeng¹, ZHU Rusen¹^,^△()

1 Department of Spine Surgery, Tianjin Union Medical Center, the First Affiliated Hospital of Nankai Unuversity, Tianjin 300121, China
2 Dehong People’s Hospital, Kunming Medical University Affiliated Dehong Hospital
3 Graduate School of Tianjin Medical University

Received:2024-12-27 Revised:2025-04-24 Published:2025-07-15 Online:2025-07-21
Contact: ^△E-mail：zrsspine@163.com

江泽华, 张伯裕, 张洪杰, 崔皓竣, 任志帅, 于浩, 周蒙蒙, 朱如森. 选择性单开门椎板成形术治疗多节段脊髓型颈椎病的疗效[J]. 天津医药, 2025, 53(7): 719-724.

JIANG Zehua, ZHANG Boyu, ZHANG Hongjie, CUI Haojun, REN Zhishuai, YU Hao, ZHOU Mengmeng, ZHU Rusen. Efficacy of selective expansive opendoor laminoplasty in the treatment of multisegmental cervical spondylotic myelopathy[J]. Tianjin Medical Journal, 2025, 53(7): 719-724.

摘要/Abstract

摘要：

目的本研究旨在评估保留C7棘突的选择性单开门椎管扩大成形术（SEOLP）治疗多节段脊髓型颈椎病的临床疗效及对颈椎矢状位参数变化的影响。方法回顾性分析因脊髓型颈椎病接受颈后路单开门椎管成形手术（EOLP）73例患者的临床数据及影像学资料。根据手术方法将患者分为SEOLP组35例和EOLP组38例。随访1年，分别记录2组患者手术时间、出血量、轴性症状、日本骨科协会（JOA）评分以及颈椎功能障碍指数（NDI）。记录2组患者围手术期的影像学资料并测量C2—C7 Cobb角、C2—C7矢状位垂直轴（SVA）、T1倾斜角（T1S），计算颈椎曲度指数（CCI）以及颈椎活动度（ROM）。观察围手术期临床疗效以及颈椎矢状位参数的变化，并分析它们之间的相关性。结果围手术期2组患者出血量、手术时间、各随访时间点JOA评分等比较差异无统计学意义（P>0.05）。术后随访SEOLP组出现轴性症状5例，EOLP组14例，2组患者轴性症状的评分、发生率以及严重程度比较差异有统计学意义（P<0.05）。2组患者术后1年NDI指数分别为21.1±2.3和24.8±3.5（P<0.01）。术后各随访点2组之间T1S和C2—C7 Cobb角比较差异无统计学意义（P>0.05）。术后1年，2组患者CCI指数分别为13.4±2.7和12.1±2.4（P<0.05），2组C2—C7 SVA分别为（22.4±3.8）mm和（26.7±5.9）mm（P<0.01）。相关性分析结果显示2组患者临床功能改善NDI指数和影像学参数C2—C7 SVA变化呈现明显负相关。结论 SEOLP术后C2—C7 SVA恢复更快，对颈椎功能影响更小，轴性症状发生程度及发生率更低。

关键词: 脊髓型颈椎病, 颈后路单开门椎管成形术, 轴性症状, 矢状位参数, 临床疗效

Abstract:

Objective To evaluate the clinical efficacy of selective expansive open-door laminoplasty (SEOLP) with preservation of C7 spinous process in the treatment of multisegmental cervical spondylotic myelopathy and its impact on changes in sagittal parameters of cervical spine. Methods A retrospective analysis was conducted on the clinical data and radiological information of 73 patients who underwent expansive open-door laminoplasty (EOLP) for cervical spondylotic myelopathy in our department between March 2018 and June 2022. Patients were divided into the SEOLP group (n=35) and the EOLP group (n=38) based on the surgical method. Follow-up was conducted for one year. The operation time, blood loss, axial symptom scores, JOA scores, VAS scores and neck disability index (NDI) were recorded in two groups of patients. Radiological data were also recorded for both groups during the perioperative period, and the C2-7 Cobb angle, C2-7 SVA and T1 slope were measured. The cervical curvature index (CCI) and cervical range of motion (ROM) were calculated. The perioperative clinical outcomes and changes in cervical sagittal parameters were observed, and their correlations were analyzed. Results There were no significant differences in blood loss, operation time, JOA scores at various follow-up time points between the two groups (P>0.05). During postoperative follow-up, axial symptoms were observed in 5 patients in SEOLP group and 14 patients in EOLP group. There were statistically significant differences in axial symptom scores, incidence and severity of axial symptoms between the two groups (P<0.05). The NDI indices at one year after operation were 21.1±2.3 for SEOLP group and 24.8±3.5 for EOLP group respectively (P<0.01). There were no statistically significant differences in T1 slope and C2-7 Cobb angle at various follow-up time points after surgery between the two groups (P>0.05). One year after operation, CCI indices for two groups were (13.4±2.7) and (12.1±2.4), respectively, with a statistically significant difference (t=2.178, P<0.05). The C2-C7 SVA values for two groups at one year after operation were (22.4±3.8) mm and (26.7±5.9) mm, respectively (t=3.667, P<0.01). The results of the correlation analysis showed that there was a significant negative correlation between clinical functional improvement (NDI) and changes of the radiological parameter C2-C7 SVA in both groups of patients. Conclusion After SEOLP, the recovery of C2-C7 SVA is faster and has less impact on cervical spine function, and the occurrence degree and incidence of axial symptoms are lower.

Key words: cervical spondylotic myelopathy, posterior cervical single open-door laminoplasty, axial symptoms, sagittal parameters, clinical efficacy

中图分类号:

R681.531.1

图/表 6

参考文献 22

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组别	n	年龄/岁	病程/年	性别（女/男）	住院时间/d	出血量/mL	手术时间/min
SEOLP组	35	55.5±6.9	3.6±1.1	16/19	12.1±3.4	171.2±33.3	111.6±18.5
EOLP组	38	52.7±6.3	3.3±0.9	17/21	13.5±3.7	185.6±34.7	123.7±19.2
t或χ²		1.812	1.281	0.012	1.678	1.806	2.734^＊

组别	n	年龄/岁	病程/年	性别（女/男）	住院时间/d	出血量/mL	手术时间/min
SEOLP组	35	55.5±6.9	3.6±1.1	16/19	12.1±3.4	171.2±33.3	111.6±18.5
EOLP组	38	52.7±6.3	3.3±0.9	17/21	13.5±3.7	185.6±34.7	123.7±19.2
t或χ²		1.812	1.281	0.012	1.678	1.806	2.734^＊

组别	n		JOA评分/分				NDI指数
组别	n		术前	术后1年		t	术前		术后1年		t
SEOLP组	35		8.4±1.8	14.5±2.5		11.675^＊＊	41.5±3.1		21.1±2.3		31.322^＊＊
EOLP组	38		8.6±1.5	14.8±3.1		11.085^＊＊	40.8±2.9		24.8±3.5		21.717^＊＊
t			0.517	0.452			0.978		5.282^＊＊
组别		轴性症状
组别		出现时间/d			严重程度（轻/中/重）			发生轴性症状		疼痛VAS评分/分
SEOLP组		11.3±3.2			4/1/0			5（14.2）		7.2±0.5
EOLP组		11.6±3.3			4/7/3			14（36.8）		9.8±0.7
t、Z或χ²		0.388			2.187^＊			2.194^＊		18.123^＊＊

组别	n		JOA评分/分				NDI指数
组别	n		术前	术后1年		t	术前		术后1年		t
SEOLP组	35		8.4±1.8	14.5±2.5		11.675^＊＊	41.5±3.1		21.1±2.3		31.322^＊＊
EOLP组	38		8.6±1.5	14.8±3.1		11.085^＊＊	40.8±2.9		24.8±3.5		21.717^＊＊
t			0.517	0.452			0.978		5.282^＊＊
组别		轴性症状
组别		出现时间/d			严重程度（轻/中/重）			发生轴性症状		疼痛VAS评分/分
SEOLP组		11.3±3.2			4/1/0			5（14.2）		7.2±0.5
EOLP组		11.6±3.3			4/7/3			14（36.8）		9.8±0.7
t、Z或χ²		0.388			2.187^＊			2.194^＊		18.123^＊＊

组别	n							C2—C7 SVA/mm					T1S/°
组别				术前				术后1年		t		术前			术后1年		t
SEOLP组		35	20.1±6.5				22.4±3.8		1.503		23.7±2.3			27.1±2.7		13.292^＊＊
EOLP组		38	21.3±6.6				26.7±5.9		3.760^＊＊		23.4±2.9			28.1±3.1		12.463^＊＊
t			0.781				3.667^＊＊				0.482			1.519
组别	C2—C7 Cobb角/°							ROM/°					CCI指数
组别	术前			术后1年		t		术前		术后1年		t	术前		术后1年		t
SEOLP组	20.4±5.6				18.2±4.3	1.921		26.5±4.1		23.3±3.6		3.472^＊＊	15.8±4.2		13.4±2.7		2.843^＊＊
EOLP组	21.1±6.0				18.6±4.0	2.147^＊		27.7±4.3		24.1±3.7		3.908^＊＊	16.4±4.4		12.1±2.4		5.294^＊＊
t	0.509				0.411			1.223		0.217			0.587		2.178^＊

选择性单开门椎板成形术治疗多节段脊髓型颈椎病的疗效

Efficacy of selective expansive opendoor laminoplasty in the treatment of multisegmental cervical spondylotic myelopathy

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组别	n	NDI指数变化值	C2—C7 SVA 变化值/mm	r
SEOLP组	35	20.4±2.8	2.2±0.6	-0.717^＊＊ -0.843^＊＊
EOLP组	38	16.9±3.3	5.2±1.0	-0.717^＊＊ -0.843^＊＊

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