| 颈椎管狭窄症并椎间盘突出颈后路单开门椎管扩大椎板成形术后椎间盘的影像学改变 |
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Received:November 29, 2023
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| 作者 | Author | 单位 | Unit | E-Mail |
| 张艳东 |
ZHANG Yan-dong |
山西医科大学第二医院 第二临床医学院骨科, 山西 太原 030000 |
Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China |
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| 薛旭红 |
XUE Xu-hong |
山西医科大学第二医院 第二临床医学院骨科, 山西 太原 030000 |
Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China |
xuexuhong@163.com |
| 赵胜 |
ZHAO Sheng |
山西医科大学第二医院 第二临床医学院骨科, 山西 太原 030000 |
Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China |
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| 葛贵喧 |
GE Gui-xuan |
山西医科大学基础医学院生物化学与分子生物学教研室, 山西 太原 030000 |
Department of Biochemistry and Molecular Biology, School of Basic Medicine, Shanxi Medical University, Taiyuan 030000, Shanxi, China |
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| 张晓华 |
ZHANG Xiao-hua |
山西医科大学基础医学院生物化学与分子生物学教研室, 山西 太原 030000 |
Department of Biochemistry and Molecular Biology, School of Basic Medicine, Shanxi Medical University, Taiyuan 030000, Shanxi, China |
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| 王世雄 |
WANG Shi-xiong |
山西医科大学第二医院 第二临床医学院骨科, 山西 太原 030000 |
Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China |
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| 高泽 |
GAO Ze |
山西医科大学第二医院 第二临床医学院骨科, 山西 太原 030000 |
Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China |
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| 期刊信息：《中国骨伤》2025年38卷，第6期，第572-580页 |
| DOI：10.12200/j.issn.1003-0034.20230109 |
| 基金项目:国家自然科学基金(编号:82272575);山西省基础研究计划(编号:202203021211041) |
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目的：探讨颈后路单开门椎管扩大椎板成形术(posterior cervical expansive open-door laminoplasty,EODL)后即刻突出椎间盘是否普遍回归、回归发生率及可能影响回归的因素。
方法：收集2020年10月至2021年12月行EODL手术的29例颈椎管狭窄症并椎间盘突出患者,男24例,女5例;年龄43~81(61.3±9.0)岁;病程1~120(36.4±37.0)个月。观察C3-C7节段的3个及3个以上椎间盘病变发生情况。分别于术前、术后3 d及术后1、3、6、12个月采用颈椎日本骨科协会(Japanese Orthopaedic Association,JOA)评分评估临床疗效。采用多点面积法和二维距离法对手术前后突出椎间盘变化进行测量,计算突出椎间盘回归的发生率和回归百分比。测量并比较手术前后颈椎Cobb角(C3-C7)、椎间角、T1倾斜角(T1 slope,T1S)、椎管矢状径、K线角、硬膜囊矢状径等影像学参数,采用Pearson相关性分析手术前后颈椎矢状位影像学参数与突出椎间盘之间的相关性。
结果：所有患者术后切口Ⅰ级愈合,其中14例获得随访,时间3(1.00,5.25)个月。术后未出现近期及远期并发症。共测量突出椎间盘101处,其中经面积测量法得到的椎间盘回归个数为79个;经距离测量法得到的椎间盘回归个数为77个。手术前后C3-C7的Cobb角、椎间角、T1S、K线角比较,差异无统计学意义(P>0.05),而椎管矢状径、硬膜囊矢状径及JOA评分比较,差异有统计学意义(P<0.05)。椎间盘突出回归比为5%~50%,45.57%(36/79)椎间盘回归比>25%。C4,5椎间盘突出变化与C5椎体矢状面直径变化呈正相关(r=0.423,P=0.028)。C3,4椎间盘变化与C3,4椎间角变化呈负相关(r=-0.450,P=0.041)。颈椎JOA评分改善率由术后即刻的(59.54±15.07)%,改善至末次随访的(76.57±14.66)%。
结论：EODL后即刻突出椎间盘回归是普遍发生的,在满足手术适应证的前提下应尽可能选择EODL手术。椎间盘突出的回归与椎管矢状径呈正相关,采用EODL手术时应在适当范围内尽可能扩大椎管,为椎间盘的回归创造更多的机会和条件,以便取得更好的临床效果。 |
| [关键词]:颈椎管狭窄症 颈椎间盘突出 脊髓型颈椎病 椎板成形术 颈椎后路单开门 |
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| Imaging changes of the intervertebral disc after posterior cervical single door enlarged laminoplasty for cervical spinal stenosis with disc herniation |
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Abstract:
Objective To explore prevalence,incidence and possible factors of immediate herniated discs after posterior cervical expansive open-door laminoplasty (EODL).
Methods Totally 29 patients with cervical spinal stenosis and intervertebral disc herniation who underwent EODL from October 2020 to December 2021 were collected,including 24 males and 5 females,aged from 43 to 81 years old with an average of (61.3±9.0) years old;the courses of disease ranged from 1 to 120 months with an average of (36.4±37.0) months. Three or more intervertebral discs on C3-C7 were observed. The clinical efficacy was evaluated according to Japanese Orthopaedic Association (JOA) score before operation,3 days and 1,3,6 and 12 months after operation,respectively. The changes of herniated disc before and after operation were measured by multipoint area method and two dimensional distance method,and incidence and percentage of herniated disc regression were further calculated. Cervical imaging parameters such as Cobb angle (C3-C7),intervertebral angle,T1 slope (T1S),spinal canal sagittal diameter,K-line angle,dural sac sagittal diameter were measured and compared before and after operation. Pearson correlation was used to analyze correlation between cervical sagittal imaging parameters and disc herniation changes before and after operation.
Results All patients obtained grade A wound healing,and 14 of them were followed up for 3(1.00,5.25) months. There were no immediate or long term postoperative complications. Totally 101 herniated intervertebral discs were measured,of which 79 regression numbers were obtained by area measurement. The number of intervertebral disc regressions by distance measurement was 77. There was no statistically significant difference in Cobb angle, intervertebral angle, T1S and K-line angle of C3-C7 (P> 0.05),however,there were statistically significant differences in sagittal diameter of spinal canal,sagittal diameter of dural sac, and JOA score before and after operation(P<0.05). The regression ratio of disc herniation ranged from 5% to 50%,and regression ratio of disc herniation was greater than 25% in 45.57% (36/79). Disc herniation in C4,5 was positively correlated with sagittal plane diameter in C5(r=0.423,P=0.028). There was a negative correlation between changes of C3,4 and C3,4 intervertebral angle (r=-0.450,P=0.041). The improvement rate of cervical JOA score immediately after operation was (59.54±15.07)%,and postoperative follow-up improved to (76.57±14.66)%.
Conclusion Herniated disc regression immediately after EODL is a common occurrence,and EODL should be selected as far as possible under the premise of satisfying surgical indications. The regression of disc herniation is positively correlated with spinal canal sagittal diameter,and spinal canal should be enlarged as far as possible in the appropriate scope during EODL,so as to create more opportunities and conditions for disc regression and achieve better clinical results. |
| KEYWORDS:Cervical spinal stenosis Cervical disc herniation Cervical spondylotic myelopathy Laminoplasty Posterior cervical single-door |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张艳东,薛旭红,赵胜,葛贵喧,张晓华,王世雄,高泽.颈椎管狭窄症并椎间盘突出颈后路单开门椎管扩大椎板成形术后椎间盘的影像学改变[J].中国骨伤,2025,38(6):572~580 |
| 英文格式: | ZHANG Yan-dong,XUE Xu-hong,ZHAO Sheng,GE Gui-xuan,ZHANG Xiao-hua,WANG Shi-xiong,GAO Ze.Imaging changes of the intervertebral disc after posterior cervical single door enlarged laminoplasty for cervical spinal stenosis with disc herniation[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(6):572~580 |
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