Kawaguchi Yoshiharu, Kanamori Masahiko, Ishihara Hirokazu, Ohmori Kazuo, Nakamura Hiroshi, Kimura Tomoatsu
Department of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, Toyama, Japan.
Clin Orthop Relat Res. 2003 Jun(411):129-39. doi: 10.1097/01.blo.0000069889.31220.62.
The long-term outcome (> 10 years) after cervical laminoplasty was assessed and the postoperative problems were clarified. One hundred thirty-three patients had laminoplasty between 1981 and 1989 for treatment of cervical myelopathy and 126 patients were available for the current study. The clinical results were evaluated using the Japanese Orthopaedic Association score. The radiologic findings were analyzed by postural anomalies and range of motion. The average preoperative score was 9.1 points, and the postoperative score improved to 13.7 points within a year. The Japanese Orthopaedic Association score and recovery rate were maintained at 13.4 points and 55.1% at the last followup. In 20 patients, the Japanese Orthopaedic Association score worsened during the followup. The causes of deterioration were axial spread of ossification of the posterior longitudinal ligament, other spinal lesions, cerebral infarction, and peripheral neuropathy. Postoperative cervical radiculopathy occurred in nine patients. Postoperative radiculopathy resolved in five patients, but remained in four patients. Kyphotic changes were observed in eight patients. The recovery rate in patients with kyphosis was poor. The postoperative range of motion decreased to 25.1% of preoperative range of motion. Sixty one percent of patients had a reduction of range of motion. Satisfactory results of cervical laminoplasty were maintained for more than 10 years after surgery; however, there were several postoperative problems, such as neurologic deterioration, postoperative radiculopathy, progression of kyphosis, and range of motion limitation.
评估了颈椎板成形术后的长期结果(>10年),并明确了术后问题。1981年至1989年间,133例患者接受了颈椎板成形术以治疗颈椎脊髓病,其中126例患者可供本研究使用。使用日本骨科协会评分评估临床结果。通过姿势异常和活动范围分析影像学表现。术前平均评分为9.1分,术后一年内评分提高到13.7分。在最后一次随访时,日本骨科协会评分和恢复率分别维持在13.4分和55.1%。20例患者在随访期间日本骨科协会评分恶化。恶化原因包括后纵韧带骨化的轴向蔓延、其他脊柱病变、脑梗死和周围神经病变。9例患者发生术后颈神经根病。5例患者的术后神经根病得到缓解,但4例患者仍存在。8例患者观察到后凸改变。后凸患者的恢复率较差。术后活动范围降至术前活动范围的25.1%。61%的患者活动范围减小。颈椎板成形术的满意结果在术后10年以上得以维持;然而,存在一些术后问题,如神经功能恶化、术后神经根病、后凸进展和活动范围受限。