The Research Of Expansive Open-door Laminoplasty Clinical Efficacy

Objective: To analyse of cervical vertebra open-door laminoplasty for cervical spondyloticmyelopathy, cervical posterior longitudinal ligament ossification and cervical spinal cordinjurywithout fracture dislocation curative effect, discuss the surgical complications and its preventionmeasures. Methods：From January2008to September2010, There were66patients underwentexpansive open-door laminoplasty, and got the follow-up in57cases. The cervical spondyloticmyelopathy and cervical posterior longitudinal ligament ossification (group A)21cases, thecervical spinal cordinjury without fracture dislocation group (group B) in36cases. The followingassessment: the first, Using the method of the Japanese Orthopaedic Association (JOA) standardsof grading and Hirabayashi method formula to evaluate the curative effect, Evaluate preoperativeand postoperative. The second, According to Ceng Yan on the axial symptom assessment standardstatistical axial symptoms and calculated the incidence.The third, the photo preoperative andfollow-up cervical spine power tablets, measuring cervical spine and cervical spine to be analyzedin accordance with the measurement methods described by Nishituzi. The forth，CCI measuringcervical sagittal sequence of changes proposed by Ishihara, a comparative analysis.Results: Group A improvement rate was73.80%, the excellent and good rate was76.19%;Group B improvement rate was70.26%, the excellent and good rate was77.78%. Through thestatistical analysis, although the rate of excellent and good for expansive open-door laminoplastyshow no significant differences in two groups. But the postoperative JOA scores of group B stillwere lower than those of group A（t=2.5236，p＜0.05）. Axial symptoms occur at a rate of33.3%intwo groups. Through the statistical analysis on axial symptoms, axial symptoms associated withthe disease itself had no significant relationship, and the operation itself. The cervical activityreduce after expansive open-door laminoplasty, but the cervical spine is better in group A.Preoperative and postoperative cervical curvature loss (5.20±6.00)%and (6.66±8.26)%forgroups A and B, by statistical analysis of cervical single-door laminoplasty surgery could cause lossof cervical lordosis. For suspicious of incision infection after operation, there were2cases in groupB, and the incidence was3.03%, all incision redness and without pus. In2cases, the infection of incision without red after treating2weeks. In1cases of C5nerve root palsy, to treat with bed rest,neck circumference brake, the application of hormone, dehydrating agent and neurotrophic agents,and it was recovery. But it remained the residual neck shoulder numbness a long term. In2patientswith cerebrospinal fluid leakage in group B, To elevate the bed, head tall prone position, the back ofthe neck incision at the appropriate pressure, they were cured.Conclusion: The first, cervical open-door laminoplasty for the treatment of cervicalspondylotic myelopathy, cervical posterior longitudinal ligament ossification and cervical spinalcord injury without fracture dislocation all achieves good effect.The sceond, we find the axial syndrome is more common complications, when we utilizecervical open-door laminoplasty to treat the cervical spondylotic myelopathy, cervical posteriorlongitudinal ligament ossification and cervical spinal cord injury. It occurs at a rate of33.3%. Butpostoperative axial syndrome incidence is no significant difference in two groups. And the rate ofaxial syndrome lives in the country report low limits in this patient group.The third, we retain muscle of the neck semispinalis in the neck2of the spinous process onlypoint in the intraoperative, postoperative neck immobilization for a relatively short time, earlycervical back muscle function exercise. These may be reasons for the reduction of postoperativeaxial syndrome incidence is significantly lower than at home and abroad report.