目的:研究术前颈椎曲度与慢性多节段脊髓型颈椎病患者在单开门椎管扩大成形术后临床疗效的相关性,为判断患者预后提供一定依据。方法:选取我院2015年1月~2022年12月因多节段脊髓型颈椎病而采用钛板支撑单开门椎管扩大成形术治疗的94例患者。根据术前X线片结果,以颈椎Cobb角为标准将患者分为A组(n = 26)、B组(n = 25)和C组(n = 43),在颈椎MRI T2加权像中心矢状位片上测量并计算C3~C7各节段脊髓后移距离,比较三组患者C3~C7各节段脊髓后移距离差异,对患者术前及末次随访时神经功能(JOA评分)进行评价,计算三组患者末次随访时JOA评分改善率并比较其差异。结果:三组患者的年龄、性别、病程、术前JOA评分等无统计学差异(P > 0.05)。三组患者C3~C7各节段脊髓均有明显后移,但脊髓后移距离差异无统计学意义(P > 0.05)。三组患者末次随访时平均JOA改善率分别为53.22%、57.30和50%,差异无统计学意义(P > 0.05)。C5水平脊髓后移距离末次随访时JOA改善率无线性相关关系。结论:术前不同曲度的慢性脊髓型颈椎病患者术后均能获得不错的临床效果,JOA改善率与术前颈椎曲度、术后脊髓后移距离之间均无明显相关。Objective: To study the correlation between preoperative cervical curvature and clinical outcomes of chronic multilevel cervical spondylotic myelopathy patients after expansive open-door laminoplasty, and to provide a certain basis for judging the prognostic outcomes of patients. Methods: Ninety-four patients who were treated with ttitanium plate-supported expansive open-door laminoplasty for chronic cervical spondylotic myelopathy at our hospital from January 2015 to December 2022 were selected. Based on the results of preoperative radiographs, patients were categorized into the groups A (n = 26), B (n = 25) and C (n = 43) using the Cobb angle of the cervical spine as the criterion. The spinal cord posterior displacement distance at
目的:通过Meta分析评价单开门椎管扩大成形术(laminoplasty,LP)与全椎板切除减压融合术(laminectomy and fusion,LF)治疗多节段颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)的临床疗效。方法:计算机检索中国知网、万方数据库、Pubmed、Cochrane Library、EMBASE等数据库自建库起至2023年6月公开发表的对比LP与LF治疗多节段颈椎OPLL疗效的临床研究。运用Cochrane风险偏倚评估工具和纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)评价纳入研究的质量,提取相关数据,包括手术时间、术中出血量、末次随访时日本骨科协会(Japanese Orthopaedic Association,JOA)评分较术前的改善率、视觉模拟量表(visual analogue scale,VAS)评分及颈椎功能障碍指数(neck disability index,NDI)较术前的改变值、末次随访时颈椎曲度指数(cervical curvature index,CCI)、颈椎矢状面轴向距离(sagittal vertical axis,SVA)、颈椎矢状面活动度(cervical range of motion,CROM)较术前的改变值、术后并发症发生率及OPLL进展率。整理数据后应用RevMan 5.4及Stata SE 16.0软件完成Meta分析。结果:共纳入12篇文献,包括3篇随机对照研究,9篇队列研究,样本总量1496例,其中LP组患者839例,LF组患者657例。Meta分析结果显示,手术时间[WMD=-28.01,95%CI(-36.25,-19.77),P<0.00001]、术中出血量[WMD=-115.09,95%CI(-197.91,-32.27),P=0.006]、末次随访时较术前的CROM改变值[WMD=-7.83,95%CI(-8.10,-7.55),P<0.00001]、术后C5神经根麻痹发生率[OR=0.32,95%CI(0.21,0.50),P<0.00001]、术后轴性症状发生率[OR=0.44,95%CI(0.28,0.71),P=0.0006]两组间差异有统计学意义,LP组优于LF组。末次随访时较术前的CCI改变值[WMD=-0.75,95%CI(-0.92,-0.58),P<0.00001]、SVA改变值[WMD=5.49,95%CI(5.30,5.68),P<0.00001],术后OPLL进展率[OR=1.76,95%CI(1.26,2.46),P=0.0009],两组间差异亦有统计学意义,LF组优于LP组。末次随访时较术前的JOA评分改善率[WMD=-1.24,95%CI(-4.02,1.5
