颈椎双开门椎管扩大成形术中 C3 椎板切除术的术后结果的多中心观察性研究。

A Multicenter Observational Study on the Postoperative Outcomes of C3 Laminectomy in Cervical Double-door Laminoplasty.

机构信息

Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo.

University of Tokyo Spine Group (UTSG).

出版信息

Clin Spine Surg. 2021 May 1;34(4):146-152. doi: 10.1097/BSD.0000000000001100.

DOI:10.1097/BSD.0000000000001100

PMID:33086255

Abstract

STUDY DESIGN

Multicenter retrospective observational study.

OBJECTIVE

To determine the differences between C3 laminectomy (LN) and C3 laminoplasty (LP) in cervical LP.

SUMMARY OF BACKGROUND DATA

Interlaminar bony fusion after cervical LP is reported to be related to a decrease in postoperative range of motion (ROM) or neurological disorder. However, it remains uncertain whether C3 LN affects patient-reported outcomes, especially after double-door LPs. Therefore, this study aimed to investigate the effect of C3 LN compared with C3 LP in cervical double-door LP.

PATIENTS AND METHODS

Using our prospective database, consecutive patients with degenerative cervical myelopathy undergoing cervical double-door LP in 7 hospitals between April 2017 and May 2018 were enrolled. Before and 1 year after the surgeries, we collected the details of patient background data, operative factors, radiologic findings such as C2-C7 ROM angle and C2-C3 interlaminar bony fusion, the Japanese Orthopaedic Association (JOA) score, postoperative satisfaction, neck pain, and patient-reported outcomes such as Short Form-12 (SF-12), EuroQol 5 Dimension (EQ-5D), Neck Disability Index (NDI), and the Core Outcome Measures Index (COMI) for the neck.

RESULTS

In all, 152 patients were enrolled, including 97 undergoing C3 LP and 55 undergoing C3 LN. There were no significant differences in patient background data, complications, and operative factors. C2-C3 interlaminar bony fusion occurred more often in the C3 LP group (22.6% vs. 5.7%). There were also no differences in the C2-C7 angle, C2-C7 ROM angle, the JOA score, patient satisfaction, neck pain, SF-12, EQ-5D, NDI, and COMI between the groups.

CONCLUSIONS

C2-C3 bony fusion after cervical double-door LP occurred more often in the C3 LP group than in the C3 LN group. C3 LN resulted in similar outcomes in complication rate, radiographic outcomes, and clinical outcomes compared with those of C3 LP.

LEVEL OF EVIDENCE

Level III.

摘要

研究设计

多中心回顾性观察研究。

目的

确定颈椎管成形术中 C3 椎板切除术（LN）与 C3 椎板成形术（LP）的差异。

背景资料概要

颈椎管成形术后的椎板间骨融合与术后活动范围（ROM）减少或神经功能障碍有关。然而，C3 LN 是否会影响患者报告的结果，特别是在双开门 LP 后，仍不确定。因此，本研究旨在探讨与 C3 LP 相比，C3 LN 对颈椎双开门 LP 的影响。

患者和方法

使用我们的前瞻性数据库，连续纳入 2017 年 4 月至 2018 年 5 月在 7 家医院接受颈椎双开门 LP 的退行性颈椎病患者。手术前后，收集患者背景资料、手术因素、影像学表现（C2-C7ROM 角和 C2-C3 椎板间骨融合）、日本骨科协会（JOA）评分、术后满意度、颈部疼痛、SF-12、EQ-5D、NDI 和颈部 COMI 等患者报告的结果。

结果

共纳入 152 例患者，其中 97 例行 C3 LP，55 例行 C3 LN。两组患者的背景资料、并发症和手术因素无显著差异。C3 LP 组 C2-C3 椎板间骨融合发生率较高（22.6%比 5.7%）。两组间 C2-C7 角、C2-C7 ROM 角、JOA 评分、患者满意度、颈部疼痛、SF-12、EQ-5D、NDI 和 COMI 差异均无统计学意义。