Kotani Yoshihisa, Abumi Kuniyoshi, Ito Manabu, Sudo Hideki, Takahata Masahiko, Ohshima Shigeki, Hojo Yoshihiro, Minami Akio
Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kitaku, Sapporo, 060-8638, Japan.
Eur Spine J. 2009 May;18(5):663-71. doi: 10.1007/s00586-009-0892-1. Epub 2009 Feb 12.
In this retrospective cohort study, two surgical methods of conventional open-door laminoplasty and deep extensor muscle-preserving laminoplasty were allocated for the treatment of cervical myelopathy, and were specifically compared in terms of axial pain, cervical spine function, and quality of life (QOL) with a minimum follow-up period of 2 years. Eighty-four patients were divided into two groups and received either a conventional open-door laminoplasty (CL group) or laminoplasty using a deep extensor muscle-preserving approach (MP group). The latter approach was performed by preserving multifidus and semispinalis cervicis attachments followed by open-door laminoplasty and re-suture of the bisected spinous processes at each decompression level. The average follow-up period was 38 months (25-53 months). The preoperative and follow-up evaluations included the original Japanese Orthopaedic Association (JOA) score, the new tentative JOA score including cervical spine function and QOL, and the visual analogue scale (VAS) of axial pain. Radiological analyses included cervical lordosis and flexion-extension range of motion (flex-ext ROM) (C2-7), and deep extensor muscle areas on MR axial images. The JOA recovery rates were statistically equivalent between two groups. The MP group demonstrated a statistically superior cervical spine function (84% vs 63%) and QOL (61% vs 45%) when compared to the CL group at final follow-up (P < 0.05). The average VAS scores at final follow-up were 2.3 and 4.9 in MP and CL groups (P < 0.05). The cervical lordosis and flex-ext ROM were statistically equivalent. The percent deep muscle area on MRI demonstrated a significant atrophy in CL group compared to that in MP group (56% vs 88%; P < 0.01). Laminoplasty employing the deep extensor muscle-preserving approach appeared to be effective in reducing the axial pain and deep muscle atrophy as well as improving cervical spine function and QOL when compared to conventional open-door laminoplasty.
在这项回顾性队列研究中，采用传统开门式椎板成形术和保留深层伸肌的椎板成形术这两种手术方法治疗脊髓型颈椎病，并在至少2年的随访期内，就轴性疼痛、颈椎功能和生活质量（QOL）进行了具体比较。84例患者被分为两组，分别接受传统开门式椎板成形术（CL组）或采用保留深层伸肌入路的椎板成形术（MP组）。后一种入路是通过保留多裂肌和颈半棘肌附着点，然后进行开门式椎板成形术，并在每个减压节段重新缝合劈开的棘突。平均随访期为38个月（25 - 53个月）。术前和随访评估包括原始日本骨科学会（JOA）评分、包括颈椎功能和生活质量的新暂定JOA评分以及轴性疼痛的视觉模拟量表（VAS）。影像学分析包括颈椎前凸和屈伸活动范围（C2 - 7）以及MR轴位图像上的深层伸肌面积。两组间JOA恢复率在统计学上相当。在末次随访时，与CL组相比，MP组在颈椎功能（84%对63%）和生活质量（61%对45%）方面表现出统计学上的优势（P < 0.05）。MP组和CL组末次随访时的平均VAS评分分别为2.3和4.9（P < 0.05）。颈椎前凸和屈伸活动范围在统计学上相当。MRI上深层肌肉面积百分比显示，CL组与MP组相比有明显萎缩（56%对88%；P < 0.01）。与传统开门式椎板成形术相比，采用保留深层伸肌入路的椎板成形术在减轻轴性疼痛和深层肌肉萎缩以及改善颈椎功能和生活质量方面似乎是有效的。
