颈椎椎板成形术后无需强制使用颈托固定：一项随机对照试验
Collar Fixation Is Not Mandatory After Cervical Laminoplasty: A Randomized Controlled Trial.
作者信息
Hida Tetsuro, Sakai Yoshihito, Ito Kenyu, Ito Sadayuki, Imagama Shiro, Ishiguro Naoki, Harada Atsushi
机构信息
Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Ohbu, Aichi Japan.
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Ohbu, Aichi Japan.
出版信息
Spine (Phila Pa 1976). 2017 Mar;42(5):E253-E259. doi: 10.1097/BRS.0000000000001994.
STUDY DESIGN
Prospective randomized controlled study.
OBJECTIVES
To determine the effect of collar-aided fixation on outcomes after laminoplasty for cervical compressive myelopathy.
SUMMARY OF BACKGROUND DATA
Patients are often placed in a Philadelphia collar for weeks after cervical laminoplasty. However, the benefit of postoperative collar use remains controversial. We hypothesized that treatment outcomes in postoperative pain in patients without collars would not be inferior to the outcomes in patients using Philadelphia collars for 2 weeks.
METHODS
This trial analyzed 74 patients (52 males, 22 females, mean age 72.7 years) with cervical compressive myelopathy who had undergone double-door laminoplasty. Before surgery, we randomly assigned patients to the collar-fixation (CF) group (postoperative Philadelphia collar for 2 weeks) or the no-collar (NC) group. The primary outcome was the visual analog scale (VAS) for cervical pain up to 1 year after surgery. Secondary outcomes were Japanese Orthopedics Association score, Short Form 36 score (SF-36), cervical range of motion (ROM), lordotic angle, and complications.
RESULTS
VAS scores up to 1 year after operation were similar with or without collar fixation (P = 0.487, two-way ANOVA). JOA scores improved significantly in both groups (P = 0.002 in CF, P < 0.001 in NC). There was no statistically significant difference between groups with regard to the improvement of JOA scores (54.9% in CF, 47.0% in NC, P = 0.80). The improvement in SF-36 was similar in both groups. Loss of ROM and lordotic angle of the cervical spine did not differ between groups (P = 0.61 in CF, P = 0.82 in NC). The incidence of complications was similar in both groups.
CONCLUSION
The VAS scores of cervical pain with the postoperative treatment without collar fixation were not inferior to those when using Philadelphia collars for 2 weeks. Moreover, other outcomes such as JOA scores, SF-36, ROM, lordotic angle, and complications were similar in both groups.
LEVEL OF EVIDENCE
研究设计
前瞻性随机对照研究。
目的
确定颈托辅助固定对颈椎管狭窄症椎板成形术后疗效的影响。
背景资料总结
颈椎椎板成形术后患者通常需佩戴费城颈托数周。然而，术后使用颈托的益处仍存在争议。我们假设不使用颈托的患者术后疼痛的治疗效果不会低于使用费城颈托2周的患者。
方法
本试验分析了74例接受双开门椎板成形术的颈椎管狭窄症患者（52例男性，22例女性，平均年龄72.7岁）。手术前，我们将患者随机分为颈托固定（CF）组（术后佩戴费城颈托2周）或无颈托（NC）组。主要结局指标为术后1年内颈椎疼痛的视觉模拟评分（VAS）。次要结局指标包括日本骨科协会评分、简明健康状况调查量表（SF-36）评分、颈椎活动度（ROM）、前凸角及并发症。
结果
术后1年内，有无颈托固定的VAS评分相似（P = 0.487，双向方差分析）。两组的日本骨科协会评分均显著改善（CF组P = 0.002，NC组P < 0.001）。两组间日本骨科协会评分的改善情况无统计学显著差异（CF组为54.9%，NC组为47.0%，P = 0.80）。两组SF-36评分的改善情况相似。两组颈椎ROM和前凸角的丢失情况无差异（CF组P = 0.61，NC组P = 0.82）。两组并发症的发生率相似。
结论
术后不使用颈托固定治疗的颈椎疼痛VAS评分不低于使用费城颈托2周时的评分。此外，两组的其他结局指标如日本骨科协会评分、SF-36评分、ROM、前凸角及并发症相似。
证据等级
2级。
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