Shen XiaoLong, Xu Chen, Wang Ruizhe, Zhang Zifan, Qi Min, Zhang Yizhi, Wu Huiqiao, Liu Yang, Chen Huajiang, Yuan Wen
Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.
Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
Int J Spine Surg. 2023 Apr;17(2):281-291. doi: 10.14444/8416. Epub 2023 Jan 12.
The present study aimed to assess the efficacy of a new haplo-paraspinal-muscle-preserving (HMP) laminoplasty technique in the treatment of cervical myelopathy.
The medical records of 68 patients diagnosed with multisegmental cervical myelopathy were retrospectively reviewed. Of these, 22 patients who underwent HMP laminoplasty were defined as the muscle-preserved group (MP), and 46 patients who underwent traditional open-door laminoplasty were enrolled and defined as the traditional open-door laminoplasty group (LP). Patient demographic data and surgical parameters like clinical and radiological parameters, operation duration, blood loss, and spinal canal expansion distance were compared.
Average surgical time and blood loss were significantly reduced in the MP group when compared with the LP group ( < 0.05). Both groups demonstrated significant improvements in neurological function and spinal canal expansion ( > 0.05). However, the visual analog scale score in the MP group was significantly lower compared with the LP group at the 6-month follow-up ( < 0.05), but no differences were found at the 1-year follow-up. The loss of lordosis was more prominent in the LP group when compared with the MP group at 1-year follow-up ( < 0.05). Lower events of persistent axial pain were found in the MP group but with no statistical significance. More hinge side laminae fractures could be found in the MP group, but more hinge side displacements were found in the LP group.
The HMP laminoplasty technique is relatively safe, effective, easier to perform, and better for lordosis maintenance and complication control compared with the traditional open-door technique.
Although traditional open-door laminoplasty is an efficient approach in treating multisegmental cervical myelopathy, the complications could significantly affect the clinical outcome. Our new HMP laminoplasty technique has a lower complication rate and a better lordosis maintenance ability; therefore, it could be a better choice in treating multisegmental cervical myelopathy.
本研究旨在评估一种新的保留半椎旁肌的单开门椎管扩大成形术（HMP）治疗脊髓型颈椎病的疗效。
回顾性分析68例多节段脊髓型颈椎病患者的病历资料。其中，22例行HMP椎管扩大成形术的患者被定义为保留肌肉组（MP），46例行传统单开门椎管扩大成形术的患者被纳入并定义为传统单开门椎管扩大成形术组（LP）。比较患者的人口统计学数据以及临床和影像学参数、手术时间、失血量、椎管扩大距离等手术参数。
与LP组相比，MP组的平均手术时间和失血量显著减少（<0.05）。两组的神经功能和椎管扩大均有显著改善（>0.05）。然而，在6个月随访时MP组的视觉模拟评分显著低于LP组（<0.05），但在1年随访时未发现差异。在1年随访时，LP组的颈椎前凸丢失比MP组更明显（<0.05）。MP组持续性轴性疼痛事件较少，但无统计学意义。MP组铰链侧椎板骨折较多，但LP组铰链侧移位较多。
与传统单开门技术相比，HMP椎管扩大成形术相对安全、有效，操作更简便，在维持颈椎前凸和控制并发症方面更具优势。
虽然传统单开门椎管扩大成形术是治疗多节段脊髓型颈椎病的有效方法，但并发症可能会显著影响临床疗效。我们新的HMP椎管扩大成形术并发症发生率较低，维持颈椎前凸能力更好；因此，它可能是治疗多节段脊髓型颈椎病的更好选择。
