[1]高阳张凤山.保留双侧C2半棘肌重建颈后伸肌附着点在颈后路单开门椎管扩大成形术中的临床效果分析[J].中国微创外科杂志,2026,01(3):0.
　Gao Yang,Zhang Fengshan..Analysis of the Clinical Effect of Reconstructing the Attachment Points of the Posterior Cervical Extensor Muscles by Preserving the Bilateral C2 Hemipinous Muscles in Expansive Opendoor Laminoplasty[J].Chinese Journal of Minimally Invasive Surgery,2026,01(3):0.
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保留双侧C2半棘肌重建颈后伸肌附着点在颈后路单开门椎管扩大成形术中的临床效果分析()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2026年3期
页码:
0
栏目:
临床论著
出版日期:
2026-03-26

文章信息/Info

Title:
Analysis of the Clinical Effect of Reconstructing the Attachment Points of the Posterior Cervical Extensor Muscles by Preserving the Bilateral C2 Hemipinous Muscles in Expansive Opendoor Laminoplasty
作者:
高阳张凤山
(北京大学第三医院骨科，北京100191)
Author(s):
Gao Yang;  Zhang Fengshan.
Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
关键词:
脊髓型颈椎病; 颈后路单开门椎管扩大成形术; C2半棘肌; 轴性症状; 支撑钛板
Keywords:
Cervical spondylotic myelopathy; Posterior cervical expansive opendoor laminoplasty; C2 hemipinous muscle; Axial symptoms; Supporting titanium plate
文献标志码:
A
摘要:
目的探讨在颈后路单开门椎管扩大成形术中，保留双侧C2半棘肌，并采用支撑钛板联合高强度不可吸收线重建棘突断端颈后伸肌附着点的临床效果。方法回顾性收集我院2023年1~6月99例脊髓型颈椎病的临床资料，按照主刀手术习惯不同分为改良组(n=49)与对照组(n=50)。改良组行颈后路单开门椎管扩大成形术，保留双侧C2半棘肌及一侧肌肉韧带复合体，并行支撑钛板固定及不可吸收线重建棘突断端颈后伸肌附着点；对照组行单纯颈后路单开门椎管扩大成形术，保留一侧肌肉韧带复合体并采用支撑钛板固定。比较2组手术时间、术中出血量、术后引流量、住院时间、术后颈部疼痛视觉模拟评分(Visual Analogue Scale, VAS)及颈椎曲度及活动度变化情况。采用日本骨科协会(Japanese Orthopaedic Association,JOA)评分评估术后脊髓功能改善情况。结果所有患者手术均顺利完成，无严重脊髓损伤或神经症状加重病例。2组手术时间、术中出血量、术后引流量、住院时间均无显著统计学差异(P>0.05)。术后6个月，改良组JOA评分为(15.9±0.9)分，改善率为(78.4±15.5)%，对照组JOA评分为(16.1±08)分，改善率为(78.5±14.8)%，2组术后6个月JOA评分及改善率差异无统计学意义(P>0.05)。改良组术后3个月颈痛VAS评分为(1.8±1.0)分，其中3例颈痛未缓解(VAS评分持续≥5分)，轴性症状发生率为6.1%（3/49）；对照组术后3个月颈痛VAS评分为(2.6±1.8)分，其中12例颈痛未缓解(VAS评分持续≥5分)，轴性症状发生率为24.0%（12/50）。2组术后3个月颈痛VAS评分及轴性症状发生率有显著性差异(P＜0.05)。随访6个月，改良组颈痛VAS评分降至(1.6±0.9)分，轴性症状发生率降至4.1%（2/49）；对照组颈痛VAS评分降至(2.2±1.5)分，轴性症状发生率降至12.0%（6/50）。2组颈痛VAS评分有显著性差异(P=0.013)，轴性症状发生率差异无统计学意义(P=0.282)。改良组术后6个月颈椎活动度为31.1°±11.8°，对照组为23.6°±10.0°，2组颈椎活动度差异有显著性(P=0.001)。结论在颈后路单开门椎管扩大成形术中，保留双侧C2半棘肌及一侧肌肉韧带复合体，并采用支撑钛板固定联合高强度不可吸收缝线重建颈后伸肌附着点，可有效减轻术后颈痛症状，降低术后早期轴性症状发生率，改善术后颈椎活动度，且未显著增加手术时间、术中出血量及术后引流量。
Abstract:
ObjectiveTo explore the clinical effect of preserving bilateral C2 hemipinous muscles and using a supporting titanium plate combined with highstrength nonabsorbable sutures to reconstruct the attachment point of the posterior cervical extensor muscles at the spinous process end in a singleopening posterior cervical canal enlargement plasty.MethodsClinical data of 99 patients with cervical spondylotic myelopathy admitted to our hospital from January to June 2023 were retrospectively collected. They were divided into the modified group (n=49) and the control group (n=50) according to the different chief surgeon’s habits. The modified group underwent posterior cervical singledoor spinal canal dilation and plasty, preserving bilateral C2 hemipinous muscles and one muscleligament complex. Titanium plates were used for fixation and nonabsorbable sutures were used to reconstruct the attachment points of the posterior cervical extensor muscles at the spinous process ends. The control group underwent simple posterior cervical singledoor spinal canal dilation and plasty, with one side of the muscleligament complex retained and fixed with a supporting titanium plate. The operation time, intraoperative blood loss, postoperative drainage volume, hospital stay, postoperative Visual Analogue Scale (VAS) of neck pain, and changes in cervical curvature and range of motion were compared between the two groups. The improvement of spinal cord function after surgery was evaluated by using the Japanese Orthopaedic Association (JOA) score.ResultsThe surgeries of all the patients were successfully completed, and there was no severe spinal cord injury or aggravation of neurological symptoms. There were no significant statistical differences in the operation time, intraoperative blood loss, postoperative drainage volume, and hospital stay between the two groups (P>0.05). At 6 months after the operation, the JOA score of the modified group was (15.9±0.9) points, and the improvement rate was (78.4±15.5)%. The JOA score of the control group was (16.1±08) points, and the improvement rate was (78.5±14.8)%. There was no statistically significant difference in the JOA score and improvement rate between the two groups at 6 months after the operation (P>0.05). The VAS score of neck pain in the modified group was (1.8±1.0) points at 3 months after the operation. Among them, the neck pain was not relieved in 3 cases (VAS score persisted ≥5 points), and the incidence of axial symptoms was 6.1% (3/49). The VAS score of neck pain in the control group was (2.6±1.8) points at 3 months after the operation. Among them, 12 cases had no relief of neck pain (VAS score persisted ≥ 5 points), and the incidence of axial symptoms was 24.0%(12/50). There were significant differences in the VAS score of neck pain and the incidence of axial symptoms between the two groups at 3 months after surgery (P<0.05). After a 6month followup, the VAS score of neck pain in the modified group decreased to (1.6±0.9) points, and the incidence of axial symptoms decreased to 4.1%(2/49). The VAS score of neck pain in the control group decreased to (2.2±1.5) points, and the incidence of axial symptoms decreased to 12.0%(6/50). There was a significant difference in the VAS score of neck pain between the two groups (P=0.013), but no statistically significant difference in the incidence of axial symptoms (P=0.282). The cervical range of motion in the modified group was 31.1°±11.8°at 6 months after the operation, and that in the control group was 23.6°±10.0°. There was a significant difference in the cervical range of motion between the two groups (P=0.001).

参考文献/References:

[1]Fehlings M,Tetreault L,Wilson J,et al.Cervical spondylotic myelopathy:current state of the art and future directions.Spine(Phila Pa 1976),2013,38(9):S1-S8.
[2]Alli S,Anderson I,Khan S.Cervical spondylotic myelopathy.Br J Hosp Med (Lond),2017,78(3):C34-C37.
[3]高阳,王勇,刘阳,等.颈后路单开门椎管扩大成形术后即刻保持常压引流与负压引流效果的比较.中国微创外科杂志,2024,24(8):553-557.
[4]Zhang L,Chen J,Cao C,et al.Anterior versus posterior approach for the therapy of multilevel cervical spondylotic myelopathy:a metaanalysis and systematic review.Arch Orthop Trauma Surg,2019,139(6):735-742.
[5]Montano N,Ricciardi L,Olivi A.Comparison of anterior cervical decompression and fusion versus laminoplasty in the treatment of multilevel cervical spondylotic myelopathy:a metaanalysis of clinical and radiological outcomes.World Neurosurg,2019,130(10):530-536.
[6]Yoshii T,Sakai K,Hirai T,et al.Anterior decompression with fusion versus posterior decompression with fusion for massive cervical ossifcation of the posterior longitudinal ligament with a ≥50% canal occupying ratio:a multicenter retrospective study.Spine J,2016,16(11):1351-1357.
[7]Wang LN,Wang L,Song YM,et al.Clinical and radiographic outcome of unilateral opendoor laminoplasty with alternative levels centerpiece miniplate fixation for cervical compressive myelopathy:a fiveyear followup study.Int Orthop,2016,40(6):1267-1274.
[8]Zhang X,Gao Y,Gao K,et al. Factors associated with postoperative axial symptom after expansive opendoor laminoplasty:retrospective study using multivariable analysis.Eur Spine J,2020,29(11):2838-2844.
[9]Stephens B,Rhee J,Neustein T,et al.Laminoplasty does not lead to worsening axial neck pain in the properly selected patient with cervical myelopathy:a comparison with laminectomy and fusion.Spine(Phila PA 1976),2017,42(24):1844-1850.
[10]Hosono N,Yonenobu K,Ono K.Neck and shoulder pain after laminoplasty.A noticeable complication.Spine (Phila Pa 1976),1996,21(17):1969-1973.
[11]Takeuchi K,Yokoyama T,Aburakawa S,et al.Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-7 laminoplasty:a modified laminoplasty preserving the semispinalis cervicis inserted into axis.Spine (Phila Pa 1976),2005,30(22):2544-2549.
[12]Nakashima H,Tetreault L,Kato S,et al.Prediction of outcome following surgical treatment of cervical myelopathy based on features of ossification of the posterior longitudinal ligament:a systematic review.JBJS Rev,2017,5(2):1-5.
[13]Sakai K,Yoshii T,Arai Y,et al.Impact of preoperative cervical sagittal alignment for cervical myelopathy caused by ossification of the posterior longitudinal ligament on surgical treatmnt.J Orthop Sci,2022,27(6):1208-1214.
[14]Zhang H,Lu S,Sun T,et al.Effect of lamina open angles in expansion opendoor laminoplasty on the clinical results in treating cervical spondylotic myelopathy.J Spinal Disord Tech,2015,28(3):89-94.
[15]Ruan C,Jiang W,Lu W,et al.Analysis of risk factors for axial symptoms after posterior cervical opendoor laminoplasty.J Orthop Surg Res,2023,18(1):954.
[16]Hosono N,Sakaura H,Mukai Y,et al.The source of axial pain after cervical laminoplasty：C7 is more crucial than deep extensor muscles.Spine(Phila Pa 1976),2007,32(26):2985-2988.
[17]Zhang K,Xiong Z,Zhang Y,et al.Risk factors of axial symptoms after posterior cervical spine surgery:a metaanalysis.BMC Surg,2025,25(1):380.
[18]Tsuji T,Asazuma T,Masuoka K,et al.Retrospective cohort study between selective and standard C3-7 laminoplasty. Minimum 2year followup study.Eur Spine J,2007,16(12):2072-2077.
[19]Kimura A,Shiraishi Y,Inoue H,et al.Predictors of persistent axial neck pain after cervical laminoplasty.Spine (Phila Pa 1976),2018,43(1):10-15.
[20]Gong T,Su X,Xia Q,et al. Analysis of reason for postoperative axial pain caused by unilaterally opendoor cervical laminoplasty.Zhongguo Gu Shang,2018,31(1):23-29.
[21]Fujita T,Takeuchi K,Yokoyama T,et,al.The effect of disruption of the repaired nuchal ligament on clinical outcomes after posterior cervical spine surgery:a retrospective comparative study.Acta Orthop Traumatol Turc,2022,56(2):131-137.
[22]Takeuchi K,Yokoyama T,Aburakawa S,et al.Anatomic study of the semispinalis cervicis for reattachment during laminoplasty.Clin Orthop Relat Res,2005,6(436):126-131.
[23]Healy A,Lubelski D,West J,et al.Biomechanics of opendoor laminoplasty with and without preservation of posterior structures.J Neurosurg Spine,2016,24(5):746-751.
[24]Chen C,Yang C,Yang S,et al.Clinical and radiographic outcomes of modifed unilateral opendoor laminoplasty with posterior muscleligament complex preservation for cervical spondylotic myelopathy.Spine(Phila Pa 1976),2019,44(24):1697-1704.
[25]Liang Z, Xu G, Liu T, et al. Quantitatively biomechanical response analysis of posterior musculature reconstruction in cervical singledoor laminoplasty. Comput Methods Programs Biomed,2023,233(5):479-480.
[26]Liu G,Fung G,Tan J,et al.A feasibility study of a new muscle sparing “C3 domehybrid opendoor laminoplasty”:a surgical technique,clinical outcome,and learning curve description.Spine (Phila Pa 1976),2020,45(19):E1256-E1263.
[27]Lin W,Song J,Zhang Y,et al.Comparison of clinical outcomes of modified laminoplasty with preservation of muscle group inserted into C2 and C7 spinous processes versus conventional C3-C7 laminoplasty:a prospective,randomized,controlled,noninferiority trial.Int J Surg,2023,109(4):905-912.
[28]Shen X,Xu C,Wang R,et al.Evaluation of haploparaspinalmusclepreserving technique to prevent postoperative axial pain in cervical laminoplasty.Int J Spine Surg,2023,17(2):281-291.
[29]Uehara T,Tsushima E,Yamada S,et al.A randomized controlled trial for the intervention effect of early exercise therapy on axial pain after cervical laminoplasty.Spine Surg Relat Res,2021,6(2):123-132.
[30]Brannigan J,Dohle E,Critchley G,et al.Adverse events relating to prolonged hard collar immobilisation: a systematic review and metaanalysis.Global Spine J,2022,12(8):1968-1978.

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更新日期/Last Update: 2026-03-26