颈椎板切除术与后路椎板切除术和融合术：并发症利用和评估及翻修手术率的趋势。
Cervical Laminoplasty Versus Posterior Laminectomy and Fusion: Trends in Utilization and Evaluation of Complication and Revision Surgery Rates.
机构信息
From the Rhode Island Hospital, Providence, RI (McDonald, DiSilvestro, Zhang, Kuris, and Daniels), Warren Alpert Medical School/Brown University, Providence, RI (McDonald, Hogan, Alsoof, Kuris, and Daniels), and Massachusetts General Hospital, Harvard Medical School, Boston, MA (Hershman).
出版信息
J Am Acad Orthop Surg. 2022 Sep 1;30(17):858-866. doi: 10.5435/JAAOS-D-22-00106. Epub 2022 May 30.
INTRODUCTION
Cervical laminoplasty (LP) and laminectomy with fusion (LF) are common operations used to treat cervical spondylotic myelopathy. Conflicting data exist regarding which operation provides superior patient outcomes while minimizing the risk of complications. This study evaluates the trends of LP compared with LF over the past decade in patients with cervical myelopathy and examines long-term revision rates and complications between the two procedures.
METHODS
Patients aged 18 years or older who underwent LP or LF for cervical myelopathy from 2010 to 2019 were identified in the PearlDiver Mariner Database. Patients were grouped independently (LP versus fusion) and assessed for association with common medical and surgical complications. The primary outcome was the incidence of LP versus LF for cervical myelopathy over time. Secondary outcomes were revision rates up to 5 years postoperatively and the development of complications attributable to either surgery.
RESULTS
In total, 1,420 patients underwent LP and 10,440 patients underwent LF. Rates of LP (10.5% to 13.7%) and LF (86.3% to 89.5%) remained stable, although the number of procedures nearly doubled from 865 in 2010 to 1,525 in 2019. On matched analysis, LP exhibited lower rates of wound complications, surgical site infections, spinal cord injury, dysphagia, cervical kyphosis, limb paralysis, incision and drainage/exploration, implant removal, respiratory failure, renal failure, and sepsis. Revision rates for both procedures at were not different at any time point.
CONCLUSION
From 2010 to 2019, rates of LP have not increased and represent less than 15% of posterior-based myelopathy operations. Up to 5 years of follow-up, there were no differences in revision rates for LP compared with LF; however, LP was associated with fewer postoperative complications than LF.
LEVEL OF EVIDENCE
Level III retrospective cohort study.
引言
颈椎板成形术（LP）和融合椎板切除术（LF）是治疗颈椎病脊髓病的常见手术。关于哪种手术能提供更好的患者结果，同时将并发症风险最小化，存在相互矛盾的数据。本研究评估了过去十年中 LP 与 LF 在颈椎病患者中的趋势，并检查了两种手术之间的长期翻修率和并发症。
方法
在 PearlDiver Mariner 数据库中，确定了 2010 年至 2019 年间接受 LP 或 LF 治疗颈椎病的年龄在 18 岁或以上的患者。将患者分组（LP 与融合），并评估与常见的医疗和手术并发症的相关性。主要结果是 LP 与 LF 治疗颈椎病的发病率随时间的变化。次要结果是术后 5 年内的翻修率以及归因于任何一种手术的并发症的发展。
结果
总共有 1420 名患者接受了 LP，10440 名患者接受了 LF。LP（10.5%至 13.7%）和 LF（86.3%至 89.5%）的比例保持稳定，尽管手术数量从 2010 年的 865 例增加到 2019 年的 1525 例，几乎翻了一番。在匹配分析中，LP 显示出较低的伤口并发症、手术部位感染、脊髓损伤、吞咽困难、颈椎后凸、肢体瘫痪、切开引流/探查、植入物取出、呼吸衰竭、肾衰竭和败血症的发生率。两种手术的任何时间点的翻修率都没有差异。
结论
从 2010 年到 2019 年，LP 的比例没有增加，占后路脊髓病手术的比例不到 15%。在 5 年的随访中，LP 与 LF 相比，翻修率没有差异；然而，LP 与 LF 相比，术后并发症较少。
证据水平
三级回顾性队列研究。
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