不同方式椎板切除术对颈椎曲度与活动度的影响

林国中 王振宇

（北京大学第三医院神经外科，北京 100191）

目的：观察不同方式椎板切除对颈椎曲度与活动度的影响

方法：对因颈椎管肿瘤行手术治疗的患者进行随访，测量术前、术后至少3月以后颈椎活动度与颈椎曲度。根据不同方式椎板切除术进行分组比较。

结果：共随访153例病人，随访时间3~96月，分为全椎板切除术组（101例）和半椎板切除术组（52例）。半椎板切除术组无颈椎不稳定或曲度恶化出现。全椎板切除术组切除椎板超过3个时颈椎不稳定及曲度恶化明显增加。当椎板切除术累及高应力部位（颈2或颈7），术前存在颈椎序列变化，小关节受累等可能影响术后颈椎曲度与活动度。

结论：半椎板切除术有助于保持颈椎稳定性。患者存在不稳定因素时应在术后长期随访。对于多节段椎板切除合并小关节切除可能需要行预防性融合或内固定。

[关键词]：颈椎，椎板切除，小关节切除，稳定性，生物力学

Effects of Cervical Alignment and Rang of Motion Due to Different Kind of Laminectomy (LIN Guozhong, WANG Zhenyu, Peking University Third Hospital, Beijing China, 100191)

Object: To investigate the biomechanical effects of alignment and range of motion due to different kind of laminectomy.

Method: the patients underwent laminectomy were followed up. The preoperative and postoperative (at least 3 months) range of motion and alignment of cervical spine were measured. Comparative analysis was conducted according to different kind of laminectomy.

Result: A total of 153 patients were followed up for 3 to 96 months, which were divided into total laminectomy group (101 cases) and hemi-laminectomy group (52 cases). Patients with hemi-laminectomy had no cervical instability or deterioration of alignment. When ≥3 laminea were excised in total laminectomy, incidence of instability and deterioration of alignment significantly increased. With preoperative cervical sequence changes, high-stress position (C2 or C7) and small joint involved, the postoperative cervical alignment and rang of motion may be affected.

Conclusion: The hemi-laminectomy helps to maintain the stability of cervical spine. Patients with risk factors above should be long-term followed-up post-operatively. Multi-segmental laminectomy with facetectomy may need prophylactic fusion or internal fixation

[Key words]: spine, laminectomy, facet joint excision, stability, biomechanics