C2穹顶样扩大成形术与C2扩大开门式椎板成形术治疗上颈椎后纵韧带骨化症的比较疗效及功能结局：一项回顾性队列研究
Comparative Effectiveness and Functional Outcome of C2 Dome-like Expansive Versus C2 Expansive Open-door Laminoplasty for Upper Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Cohort Study.
作者信息
Yu Chengcheng, Wu Yinan, Zhang Zengjie, Zhang Ning, Yu Xinning, Li Fangcai, Chen Weishan, Chen Qixin, Li Wanli
机构信息
Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, PR China.
Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, PR China.
出版信息
Spine (Phila Pa 1976). 2022 May 15;47(10):E448-E455. doi: 10.1097/BRS.0000000000004221. Epub 2021 Sep 14.
STUDY DESIGN
Retrospective Cohort Study.
OBJECTIVES
This study compared the function and radiographical outcomes of the patients who underwent C2 dome-like expansive laminoplasty to those C2 expansive open-door laminoplasty for the treatment of OPLL with C2 involved.
SUMMARY OF BACKGROUND DATA
There are few comparative studies of these two surgical methods. C2 dome-like and C2 expansive open-door laminoplasty are posterior approaches for posterior longitudinal ligament ossification with C2 level and above.
METHODS
This study performed a retrospective cohort analysis of 59 patients with OPLL up to C2 which cause compression symptoms. 31 patients underwent C2 dome-like expansive laminoplasty with C3-7 expansive open-door laminoplasty (Group Dom) and 28 underwent C2-7 expansive open-door laminoplasty (Group Exp). The preoperative and postoperative space available for cord (SAC) of C2 segment, cervical curvature index of C2-7, C2-7 range of motion, Japanese orthopedic association (JOA) score, visual analog scale (VAS) score, and neck disability index (NDI) were used to assess clinical out-comes and statistically analyzed.
RESULTS
The cervical curvature index, JOA score, and NDI significantly changed at the final follow-up in two groups with no significant intergroup differences. There were no significant differences in preoperative SAC and VAS between the two groups. At the final follow-up, the SAC of C2/3 in Group Exp was significantly larger than Group Dom, while the VAS and range of motion of Group Dom became significantly better than Group Exp.
CONCLUSION
The C2 dome-like expansive laminoplasty can reduce postoperative neck pain more obviously and achieve better cervical curvature. C2 expansive open-door laminoplasty can get more adequate decompression in the spinal canal, which may be recommend to the patients with OPLL occupying more than 50% of the vertebral canal at C2/3, or with developmental spinal stenosis.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
本研究比较了接受C2穹顶样扩大椎板成形术的患者与接受C2扩大开门椎板成形术治疗累及C2的后纵韧带骨化症（OPLL）患者的功能和影像学结果。
背景数据总结
这两种手术方法的比较研究较少。C2穹顶样和C2扩大开门椎板成形术是治疗C2及以上节段后纵韧带骨化症的后路手术方法。
方法
本研究对59例因C2及以上节段OPLL导致压迫症状的患者进行回顾性队列分析。31例患者接受C2穹顶样扩大椎板成形术联合C3 - 7扩大开门椎板成形术（穹顶组），28例患者接受C2 - 7扩大开门椎板成形术（扩大组）。采用术前和术后C2节段的脊髓可用空间（SAC）、C2 - 7颈椎曲度指数、C2 - 7活动度、日本骨科协会（JOA）评分、视觉模拟量表（VAS）评分和颈部功能障碍指数（NDI）评估临床结果并进行统计学分析。
结果
两组在末次随访时颈椎曲度指数、JOA评分和NDI均有显著变化，组间无显著差异。两组术前SAC和VAS无显著差异。在末次随访时，扩大组C2/3节段的SAC显著大于穹顶组，而穹顶组的VAS和活动度显著优于扩大组。
结论
C2穹顶样扩大椎板成形术能更明显减轻术后颈部疼痛并获得更好的颈椎曲度。C2扩大开门椎板成形术能在椎管内获得更充分的减压，对于C2/3节段OPLL占据椎管超过50%或合并发育性椎管狭窄的患者可能更推荐使用。
证据级别
3级。
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