Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan.
World Neurosurg. 2020 Feb;134:e581-e588. doi: 10.1016/j.wneu.2019.10.141. Epub 2019 Oct 31.
OBJECTIVE: Upper extremity sensory disturbances are primary symptoms that affect the quality of life (QOL) of patients with cervical spondylotic myelopathy. Although laminoplasty is 1 of the surgical options, its effects on sensory disturbances have remained unclear. We aimed to determine whether surgical intervention would improve the sensory disturbances of patients with cervical spondylotic myelopathy. METHODS: We conducted a prospective clinical trial of 101 patients who had undergone open door laminoplasty. For an objective sensory assessment, we measured the current perception thresholds (CPTs) in the patients' forearms and palms using PainVision PS-2100. For a subjective sensory assessment, numbness in the upper extremities was rated using a visual analog scale (VAS). Using the VAS scores, the patients were divided into those with improvement and without improvement. Their self-reported 36-item short-form health survey and Japanese Orthopaedic Association cervical myelopathy evaluation questionnaire scores were compared. RESULTS: The postoperative CPTs in relationship to the preoperative CPTs at 3, 6, and 12 months was 99.3%, 98.1%, and 93.8% in the forearm and 93.6%, 90.6%, and 87.8% in the palm, respectively. The corresponding postoperative numbness VAS scores were 63.8%, 50.5%, and 48.0%. At 12 months postoperatively, the 36-item short-form health survey physical and role component summary scores, cervical spine function effectiveness rates, upper and lower extremity function, and QOL items in the Japanese Orthopaedic Association cervical myelopathy evaluation questionnaire were significantly higher in the improvement group. CONCLUSIONS: Our findings have indicated that improvement in postoperative subjective sensory disturbances will occur relatively earlier and will be significantly greater than the improvement in objective sensory disturbances. Furthermore, improvement in the subjective sensory disturbances contributes to functional spinal cord recovery and patients' health-related QOL.
目的:上肢感觉障碍是影响颈椎病患者生活质量(QOL)的主要症状。尽管椎板成形术是一种手术选择,但对感觉障碍的影响仍不清楚。我们旨在确定手术干预是否会改善颈椎病患者的感觉障碍。
方法:我们对 101 例接受开门椎板成形术的患者进行了前瞻性临床试验。为了进行客观的感觉评估,我们使用 PainVision PS-2100 测量了患者前臂和手掌的电流感知阈值(CPT)。为了进行主观的感觉评估,使用视觉模拟量表(VAS)对上肢麻木进行了评分。根据 VAS 评分,将患者分为改善组和无改善组。比较了他们的自我报告的 36 项简短健康调查和日本矫形协会颈椎脊髓病评估问卷的评分。
结果:术后 CPT 与术前 CPT 的关系,术后 3、6 和 12 个月时前臂分别为 99.3%、98.1%和 93.8%,手掌分别为 93.6%、90.6%和 87.8%。相应的术后麻木 VAS 评分分别为 63.8%、50.5%和 48.0%。术后 12 个月,日本矫形协会颈椎脊髓病评估问卷中的 36 项简短健康调查身体和角色成分综合评分、颈椎功能有效率、上下肢功能和生活质量项目在改善组中显著更高。
结论:我们的发现表明,术后主观感觉障碍的改善将相对较早发生,并且显著大于客观感觉障碍的改善。此外,主观感觉障碍的改善有助于脊髓功能的恢复和患者的健康相关生活质量。
Acta Chir Orthop Traumatol Cech. 2015