Chen Hua, Liu Hao, Deng Yuxiao, Gong Quan, Li Tao, Song Yueming
From the Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, P.R. China.
Medicine (Baltimore). 2016 Jan;95(2):e2292. doi: 10.1097/MD.0000000000002292.
Retrospective case-control study.Unilateral expansive open-door cervical laminoplasty with miniplate fixation is an efficient and increasing popular surgery for multilevel cervical spondylotic myelopathy. Axial symptoms are the most frequent complaints after cervical laminoplasty. But the mechanisms have not been fully clarified yet.The objective of this study is to compare the clinical and radiologic data between patients with or without axial symptoms and to investigate the factors associated with axial symptoms by multivariate analysis in cervical laminoplasty with miniplate fixation.A total of 129 patients who underwent cervical laminoplasty with miniplate fixation were comprised from August 2009 to March 2014. Patients were grouped according to whether they suffered from postoperative axial symptoms (PA) or not (NA). The clinical data including gender, age, duration of symptoms, diagnosis type, medical comorbidity, operative level, blood loss, operative time, pre- and post-Japanese Orthopedic Association (JOA) score, JOA recovery rates, and other complications were recorded. The radiologic data including cervical canal diameter, C2-7 Cobb angle, cervical range of motion (ROM), cross-sectional area, open angle, hinge union, and facet joint destroyed would be measured according to X-ray plain and CT scan images. The univariate analysis and multivariate logistic regression analysis were performed.There were 39 patients in PA group and 90 patients in NA group. Both groups gained significant JOA improvement postoperatively (P < 0.05). The preoperative neck pain (P = 0.048), negative change of cervical ROM (P = 0.018), and facet joints destroyed (P = 0.022) were significant different between the 2 groups. There were no significant differences for other clinical and radiography parameters between the groups (P > 0.05). The multivariate analysis showed that the negative change of cervical ROM (OR = 1.062, P = 0.047) and facet joints destroyed (OR = 0.661, P = 0.024) were related to axial symptoms.The change of cervical ROM and facet joints destroyed by miniscrews might be associated with axial symptoms after cervical laminoplasty with miniplate fixation. Cervical spine surgeons should carefully operate to decrease the injury of posterior musculature structure and protect the facet joints.
回顾性病例对照研究。单开门颈椎扩大成形术联合微型钢板固定术是治疗多节段脊髓型颈椎病的一种有效且日益流行的手术。轴性症状是颈椎成形术后最常见的主诉。但其发病机制尚未完全阐明。本研究的目的是比较有或无轴性症状患者的临床和影像学资料，并通过多因素分析探讨单开门颈椎成形术联合微型钢板固定术中与轴性症状相关的因素。2009年8月至2014年3月共纳入129例行单开门颈椎成形术联合微型钢板固定术的患者。根据患者术后是否出现轴性症状（PA）将其分为两组，未出现轴性症状者为非轴性症状组（NA）。记录患者的临床资料，包括性别、年龄、症状持续时间、诊断类型、合并症、手术节段、失血量、手术时间、术前及术后日本骨科协会（JOA）评分、JOA恢复率及其他并发症。根据X线平片和CT扫描图像测量影像学资料，包括颈椎管直径、C2-7 Cobb角、颈椎活动度（ROM）、横截面积、开门角度、铰链愈合及关节突关节破坏情况。进行单因素分析和多因素logistic回归分析。PA组39例，NA组90例。两组术后JOA评分均显著改善（P<0.05）。两组术前颈部疼痛（P=0.048）、颈椎ROM的负向变化（P=0.018）及关节突关节破坏（P=0.022）差异有统计学意义。两组间其他临床和影像学参数差异无统计学意义（P>0.05）。多因素分析显示，颈椎ROM的负向变化（OR=1.062，P=0.047）及关节突关节破坏（OR=0.661，P=0.024）与轴性症状有关。微型螺钉导致的颈椎ROM变化及关节突关节破坏可能与单开门颈椎成形术联合微型钢板固定术后的轴性症状有关。颈椎外科医生应谨慎操作，减少对后方肌肉结构的损伤，保护关节突关节。
