Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
Department of Spine Surgery, Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Orthopaedic Research Institute, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Biomed Res Int. 2020 May 6;2020:3627071. doi: 10.1155/2020/3627071. eCollection 2020.
To analyze the ten-year surgical outcomes and postoperative complications of French-Door laminoplasty (FDL) in the management of multilevel cervical spondylotic myelopathy (MCSM) and analyze the prognostic factors for FDL in treating MCSM.
64 patients with MCSM, who were operated by FDL, were included in this study and followed up for at least 10 years. Clinical assessments including modified Japanese Orthopaedic Association (mJOA) score, age at surgery, preoperative symptom duration, operative time, blood loss and postoperative complications, radiological assessments including Cobb angle, cervical range of motion (ROM), intramedullary signal intensity on T2W MRI, canal narrowing ratio (CNR), and maximum spinal cord compression (MSCC). mJOA score, Cobb angle, cervical ROM, intramedullary signal intensity on T2W MRI, and CNR were assessed before surgery and at the final follow-up.
The average mJOA score was significantly improved from preoperative 10.32 ± 1.63 points to 15.10 ± 0.62 points at the final follow-up ( < 0.05). The average RR of the mJOA score at the final follow-up was 69.10 ± 7.32%. The cervical Cobb angle and ROM decreased significantly at the final follow-up. Patients with high intramedullary signal intensity of T2W MRI or CNR more than 50% showed a lower RR of the mJOA score. Correlation analysis revealed that preoperative symptom duration and intramedullary signal intensity of T2W MRI, CNR, MSCC, and blood loss were significantly correlated with the RR of the mJOA score. Gender, operative method, and age at surgery were significantly correlated with the preservation rate of ROM. Operative time was significantly correlated with the incidence of axial symptoms.
The ten-year clinical outcomes of FDL were satisfactory. Higher intramedullary signal intensity of T2W MRI and a greater CNR predicted poorer prognoses.
分析法国式开门椎板成形术（French-Door laminoplasty，FDL）治疗多节段脊髓型颈椎病（multilevel cervical spondylotic myelopathy，MCSM）的十年手术结果和术后并发症，并分析 FDL 治疗 MCSM 的预后因素。
本研究纳入了 64 例接受 FDL 手术的 MCSM 患者，并进行了至少 10 年的随访。临床评估包括改良日本骨科协会（modified Japanese Orthopaedic Association，mJOA）评分、手术时年龄、术前症状持续时间、手术时间、出血量和术后并发症；影像学评估包括 Cobb 角、颈椎活动度（range of motion，ROM）、T2W MRI 脊髓内信号强度、椎管狭窄率（canal narrowing ratio，CNR）和最大脊髓压迫（maximum spinal cord compression，MSCC）。mJOA 评分、Cobb 角、颈椎 ROM、T2W MRI 脊髓内信号强度和 CNR 在术前和末次随访时进行评估。
mJOA 评分从术前的 10.32 ± 1.63 分显著提高至末次随访时的 15.10 ± 0.62 分（<0.05）。mJOA 评分的末次随访时的 RR 为 69.10 ± 7.32%。颈椎 Cobb 角和 ROM 在末次随访时显著降低。T2W MRI 脊髓内高信号强度或 CNR 大于 50%的患者 mJOA 评分 RR 较低。相关性分析显示，术前症状持续时间和 T2W MRI 脊髓内信号强度、CNR、MSCC 和出血量与 mJOA 评分的 RR 显著相关。性别、手术方法和手术时年龄与 ROM 的保留率显著相关。手术时间与轴向症状的发生率显著相关。
FDL 的十年临床结果令人满意。T2W MRI 脊髓内高信号强度和较大的 CNR 预示着较差的预后。
