中国骨伤2025，Vol.38Issue(6)：572-580,9.DOI:10.12200/j.issn.1003-0034.20230109
颈椎管狭窄症并椎间盘突出颈后路单开门椎管扩大椎板成形术后椎间盘的影像学改变
Imaging changes of the intervertebral disc after posterior cervical single door enlarged laminoplasty for cervical spinal stenosis with disc herniation
摘要
Abstract
Objective To explore prevalence,incidence and possible factors of immediate herniated discs after posterior cervical expansive open-door laminoplasty(EODL).Methods Totally 29 patients with cervical spinal stenosis and interverte-bral disc herniation who underwent EODL from October 2020 to December 2021 were collected,including 24 males and 5 fe-males,aged from 43 to 81 years old with an average of(61.3±9.0)years old;the courses of disease ranged from 1 to 120 months with an average of(36.4±37.0)months.Three or more intervertebral discs on C3-C7 were observed.The clinical effica-cy was evaluated according to Japanese Orthopaedic Association(JOA)score before operation,3 days and 1,3,6 and 12 months after operation,respectively.The changes of herniated disc before and after operation were measured by multipoint area method and two-dimensional distance method,and incidence and percentage of herniated disc regression were further calculat-ed.Cervical imaging parameters such as Cobb angle(C3-C7),intervertebral angle,T1 slope(T1S),spinal canal sagittal diame-ter,K-line angle,dural sac sagittal diameter were measured and compared before and after operation.Pearson correlation was used to analyze correlation between cervical sagittal imaging parameters and disc herniation changes before and after operation.Results All patients obtained grade A wound healing,and 14 of them were followed up for 3(1.00,5.25)months.There were no immediate or long-term postoperative complications.Totally 101 herniated intervertebral discs were measured,of which 79 re-gression numbers were obtained by area measurement.The number of intervertebral disc regressions by distance measurement was 77.There was no statistically significant difference in Cobb angle,intervertebral angle,T1S and K-line angle of C3-C7(P＞0.05),however,there were statistically significant differences in sagittal diameter of spinal canal,sagittal diameter of dural sac,and JOA score before and after operation(P＜0.05).The regression ratio of disc herniation ranged from 5％to 50％,and regres-sion ratio of disc herniation was greater than 25％in 45.57％(36/79).Disc herniation in C4,5 was positively correlated with sagittal plane diameter in Cs(r=0.423,P=0.028).There was a negative correlation between changes of C3,4 and C3,4 intervertebral angle(r=-0.450,P=0.041).The improvement rate of cervical JOA score immediately after operation was(59.54±15.07)％,and postoperative follow-up improved to(76.57±14.66)％.Conclusion Herniated disc regression immediately after EODL is a common occurrence,and EODL should be selected as far as possible under the premise of satisfying surgical indications.The regression of disc herniation is positively correlated with spinal canal sagittal diameter,and spinal canal should be enlarged as far as possible in the appropriate scope during EODL,so as to create more opportunities and conditions for disc regression and achieve better clinical results.关键词
颈椎管狭窄症/颈椎间盘突出/脊髓型颈椎病/椎板成形术/颈椎后路单开门Key words
Cervical spinal stenosis/Cervical disc herniation/Cervical spondylotic myelopathy/Laminoplasty/Posterior cervical single-door分类
医药卫生引用本文复制引用
张艳东,薛旭红,赵胜,葛贵喧,张晓华,王世雄,高泽..颈椎管狭窄症并椎间盘突出颈后路单开门椎管扩大椎板成形术后椎间盘的影像学改变[J].中国骨伤,2025,38(6):572-580,9.基金项目
国家自然科学基金(编号:82272575) （编号:82272575）
山西省基础研究计划(编号:202203021211041)National Natural Science Foundation of China(No.82272575) （编号:202203021211041）
