Okada Motohiro, Minamide Akihito, Endo Toru, Yoshida Munehito, Kawakami Mamoru, Ando Muneharu, Hashizume Hiroshi, Nakagawa Yukihiro, Maio Kazuhiro
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Spine (Phila Pa 1976). 2009 May 15;34(11):1119-26. doi: 10.1097/BRS.0b013e31819c3b61.
A prospective randomized clinical study.
To compare the clinical outcomes of open-door and French-door laminoplasties.
Expansive laminoplasty for cervical compressive myelopathy is well established and a variety of modifications procedures have been developed. The procedures are mainly classified into open-door and French-door. It has never been prospectively investigated as to which surgical procedure, open-door or French-door laminoplasty, results in a more favorable outcome.
After informed consent was obtained from 40 patients, they were randomized into 2 surgical groups A and B. Patients in group A had open-door laminoplasty, and patients in group B underwent French-door laminoplasty with reattachment of the spinous process and extensor musculatures. The following criteria were evaluated: operation time, blood loss, perioperative complications, Japanese Orthopedic Association (JOA) scores, recovery rates, axial pain, and short-form 36 (SF-36). For radiographic evaluation, cervical lordosis was reviewed as lordotic angles, which were measured at C2-C7.
Although the operation time was significantly less in group A as compared with group B, the mean blood loss in group A was significantly more than group B. Perioperative complications occurred more frequently in group A than in group B. Although there were no significant differences in postoperative JOA scores and recovery rates between the 2 groups, axial pain was significantly decreased in group B at final follow-up. The scores of every subscale of the SF-36 were higher in group B than group A.
Perioperative complications occurred more frequently in open-door laminoplasty than in French-door laminoplasty. JOA scores and recovery rates suggested that both open-door and French-door laminoplasties could be similarly effective in decompressing the spinal cord. Axial pain was improved in French-door laminoplasty but became worse in open-door laminoplasty. SF-36 suggested that French-door laminoplasty could be more beneficial than open-door laminoplasty for patients with cervical compressive myelopathy.
一项前瞻性随机临床研究。
比较单开门和双开门椎板成形术的临床疗效。
扩大椎板成形术治疗颈椎压迫性脊髓病已得到广泛认可，并且已经开发了多种改良手术方法。这些手术主要分为单开门和双开门。从未对哪种手术方法（单开门或双开门椎板成形术）能产生更有利的结果进行过前瞻性研究。
在获得40例患者的知情同意后，将他们随机分为A、B两个手术组。A组患者接受单开门椎板成形术，B组患者接受双开门椎板成形术并重新附着棘突和伸肌组织。评估以下标准：手术时间、失血量、围手术期并发症、日本骨科协会（JOA）评分、恢复率、轴性疼痛和简明健康状况调查量表（SF-36）。对于影像学评估，将颈椎前凸视为前凸角，在C2-C7测量。
尽管A组的手术时间明显少于B组，但A组的平均失血量明显多于B组。A组围手术期并发症的发生率高于B组。尽管两组术后JOA评分和恢复率无显著差异，但在末次随访时B组的轴性疼痛明显减轻。B组SF-36各子量表的得分均高于A组。
单开门椎板成形术的围手术期并发症发生率高于双开门椎板成形术。JOA评分和恢复率表明，单开门和双开门椎板成形术在脊髓减压方面同样有效。双开门椎板成形术改善了轴性疼痛，而单开门椎板成形术使其加重。SF-36表明，双开门椎板成形术对颈椎压迫性脊髓病患者可能比单开门椎板成形术更有益。
