Spinal Surgery Unit, Shengjing Hospital of China Medical University, Shenyang, China.
Orthop Surg. 2021 Jul;13(5):1673-1681. doi: 10.1111/os.13026. Epub 2021 Jun 10.
This study is to introduce lift-open laminoplasty and verify the increase of the spinal canal area following this surgical technique according to the preoperative anatomical measurement.
There are 82 patients (43 male and 39 female) analyzed in our study from January 2019 to December 2020. The average age was 63.2 ± 3.21 years (from 41 to 84 years). All of them were treated with open-door laminoplasty, with a decompression segment range from C3 to C6. The increase of the spinal canal area after open-door laminoplasty was measured on postoperative CT images of the patients, and the distances between both lamina-facet junctions and lamina length was measured on preoperative CT images. Using the Pythagorean theorem for the equation of calculation area after the expansile open-door laminoplasty. Based on previous measurement parameters, spinous process length, lateral mass width, distance between osteotomy line and lamina-facet junctions line were additionally measured on preoperative CT images. Pythagorean theorem was used for calculating the area after the expansile lift-open laminoplasty. The results were recorded and a statistical analysis was undertaken. Then, there were six patients (five male and one female) treated with lift-open laminoplasty on C6, open-door on C3-C5, who suffer from cervical spondylotic myelopathy from December 2020 to January 2021. The average age was 60.3 ± 1.7 years (from 56 to 71 years). Operation time, blood loss, and Japanese Orthopaedic Association (JOA) score recovery rate were recorded. Intraoperative and postoperative complications were observed.
The increase of the spinal canal area after open-door laminoplasty measured on postoperative CT images was 123.01 ± 17.06 mm and the calculation of the increase of the spinal canal areausing the Pythagorean theorem after open-door laminoplasty was 122.86 ± 15.86 mm . A comparison of the actual value with calculative value showed no significant difference (T value = 0.057, P value = 0.955). The calculation of the increase of the spinal canal area after lift-open laminoplasty was 183.57 ± 62.99 mm , which was larger than that after open-door laminoplasty (T value = 8.462, P value < 0.001). Mean operation time was 153.3 min and operative blood loss was 600 mL of the six patients treated with lift-open laminoplasty. At 1 month follow-up, all patients had recovered well. JOA score recovery rate was 37.6% and no intraoperative and postoperative complications occurred.
Lift-open laminoplasty could preserve nearly 100% of extensor muscle, avoid damaging C7 paraspinal muscles and C6-7 posterior muscle-ligament complex, reconstruct the spinous process firmly in the midline, and expand adequate spinal canal area after operation. These advantages could reduce the incidence rate of complications and bring better clinical results than traditional laminoplasty.
本研究旨在介绍掀盖式椎板成形术，并根据术前解剖测量结果验证该手术技术对椎管面积增加的效果。
本研究纳入了 2019 年 1 月至 2020 年 12 月间的 82 例患者（男 43 例，女 39 例），平均年龄为 63.2±3.21 岁（4184 岁）。所有患者均行单开门椎板成形术，减压节段为 C3C6。术后 CT 图像上测量椎板成形术后椎管面积的增加，术前 CT 图像上测量两侧椎板-小关节突连接处之间的距离和椎板长度。利用毕达哥拉斯定理计算扩张式开门椎板成形术后的面积。基于之前的测量参数，在术前 CT 图像上还测量了棘突长度、横突宽度、截骨线与椎板-小关节突连线之间的距离。利用毕达哥拉斯定理计算扩张式掀盖式椎板成形术后的面积。记录结果并进行统计分析。然后，我们纳入了 2020 年 12 月至 2021 年 1 月间 6 例因颈脊髓病而行 C6 掀盖式、C3-C5 开门式手术的患者（男 5 例，女 1 例），平均年龄为 60.3±1.7 岁（56~71 岁）。记录手术时间、出血量和日本骨科协会（JOA）评分恢复率。观察术中及术后并发症。
术后 CT 图像上测量的开门式椎板成形术后椎管面积增加为 123.01±17.06mm，利用毕达哥拉斯定理计算的开门式椎板成形术后椎管面积增加为 122.86±15.86mm，实际值与计算值比较无显著差异（T 值=0.057，P 值=0.955）。掀盖式椎板成形术后椎管面积增加的计算值为 183.57±62.99mm，明显大于开门式椎板成形术（T 值=8.462，P 值<0.001）。6 例掀盖式椎板成形术的平均手术时间为 153.3 分钟，手术出血量为 600ml。术后 1 个月随访时，所有患者均恢复良好。JOA 评分恢复率为 37.6%，无术中及术后并发症发生。
掀盖式椎板成形术可保留近 100%的伸肌，避免损伤 C7 脊柱旁肌和 C6-7 后肌-韧带复合体，牢固重建棘突中线，术后可扩大足够的椎管面积。这些优势可降低并发症发生率，为患者带来更好的临床效果，优于传统的椎板成形术。
