| Purpose:The purpose of this study was by comparing whether patients undergoing posterior cervical single-door spinal canal enlargement and nerve root canal enlargement surgery,whether there is bone grafting on the port axis,whether the neck was moved early after surgery..Analysis of postoperative curative effect provides a certain reference for clinical work.Methods:This study is a prospective study,select 90 patients with cervical spinal stenosis from December 2017 to January 2019 in our hospital.Divide patients into three groups,after obtaining the patient's informed consent,all patients underwent posterior cervical single-door open-end spinal canal enlargement and nerve root canal enlargement with mini titanium plate internal fixation.Among them,30 patients in group A had no bone graft on the portal axis side during operation.32 patients in group B were treated with bone grafting on the portal axis side during operation.In group C,28 patients received bone grafting on the portal axis side during the operation.Based on standard exercise in other parts after surgery,mild neck movements were performed from the third day,twice a day,each time no more than 15 minutes,start with the isometric contraction of the anterior neck muscles,7 days after the operation.,isotonic exercise of neck muscles after2 weeks,the range has changed from small to large,and the activity should be gradual,the neck support is fixed after the activity.Group C was set as the early activity group.On the basis of standardized exercise in other parts after operation in groups A and B,the neck movement started from the 6th week.The bone graft materials on both sides of the door shaft of groups B and C are autogenous bone,it is the removal of spinous processes and osteophytes during surgery,crushed and refined into small bone fragments with bone pliers in advance,and then implanted on the door shaft side.All patients were treated by the same treatment group from admission to discharge,followed up for at least 12 months after surgery,and all follow-up data were also recorded by the same person.Record and analyze the general situation of the three groups of patients,basic data during the perioperative period,JOA scores before and after surgery,VAS pain scores before surgery,3 months and 1 year after surgery,and the incidence of postoperative cervical instability.The angle of total cervical motion loss after operation(°),the vertebral fusion rate at 3 and 6 months,and theincidence of postoperative complications.Based on the data calculated and recorded above,statistical software analysis was used to analyze the effects of bone graft and early activity on cervical spine surgery by t test,x2 test,and analysis of variance.Results:1.The comparison of basic data and perioperative data of the three groups of patients,the difference is not statistically significant(P> 0.05),indicating that the above data will not affect the results.2.(1)The comparison of JOA scores before operation and JOA scores of 1 year after operation in the three groups of patients were statistically significant(P <0.05),indicating that whether or not bone graft and early activity were performed,the door was opened through the posterior neck.Laminoplasty and nerve root canal expansion mini titanium plate internal fixation,all patients can get good nerve function recovery.(2)The VAS scores of the three groups of patients before surgery were compared with those at 3months and 1 year after operation.The difference was statistically significant(P <0.05),indicating that whether the bone graft or early activity was performed,the laminectomy was performed through the posterior cervical approach.Miniature titanium plate internal fixation with expanded nerve root canal can effectively reduce pain symptoms in all patients.3.Comparison of patients in group A(control group)and group B(bone graft group).(1)The difference in the rate of improvement of neurological function at 1 year after surgery is statistically significant(P <0.05),which indicates that 1 year after bone graft at the portal axis,the improvement of neural function was better than that of the non-bone graft group.(2)Comparison of VAS scores at 3 months and 1 year after operation.There was no significant difference at 3 months after operation(P> 0.05),and the difference at 1 year after operation was statistically significant(P <0.05).Postoperative pain reduction in the lateral group was better than in the control group.(3)The comparison of postoperative stability was statistically significant(P <0.05),indicating that the bone graft group was better than the control group in terms of postoperative cervical spine stability.(4)Compared with the cervical fusion rate at 3 and 6 months after operation,the difference was statistically significant(P <0.05),indicating that the bone graft group on the portal axis side was better than the control group.(5)There was no significant difference in the angle(°)of total cervical spine motion loss after operation(P> 0.05),indicating that bone grafting had no effect on the cervical spine motion.(6)The comparison of postoperative axial symptoms was statistically significant(P <0.05),indicating that the incidence of postoperative axial symptoms in the bone graft group was lessthan that in the control group.(7)There was no significant difference in the comparison of postoperative nerve root paralysis(P> 0.05),indicating that bone grafting had no effect on the occurrence of postoperative nerve root paralysis.4.Comparison of patients in group B(bone graft group)and group C(early activity group).(1)The difference in the rate of improvement of neurological function at 1 year after surgery is not statistically significant(P> 0.05),indicating that early activity has a significant effect on postoperative nerve function.Improvement has no effect.(2)Compared with the VAS scores at 3 months and 1 year after surgery,the difference was statistically significant(P <0.05),indicating that early activities can effectively reduce soft tissue adhesion and relieve postoperative pain in cervical spine.It was not statistically significant(P> 0.05),indicating that there was no difference in the reduction of postoperative pain after one year of bone graft fusion.(3)The comparison of postoperative stability was not statistically significant(P> 0.05),indicating that early activity had no effect on postoperative stability.(4)The comparison of cervical fusion rate at 3and 6 months after operation was not statistically significant(P> 0.05),indicating that early slight cervical movement had no effect on cervical fusion rate.(5)Compared with the angle of loss of total cervical mobility after surgery(°),the difference is statistically significant(P <0.05),which indicates that the angle of loss of cervical mobility of patients with early active cervical spine is less,and the effect on postoperative mobility is small.(6)Compared with axial symptoms,the difference was not statistically significant(P> 0.05),indicating that early activity had no effect on the occurrence of axial symptoms after surgery.Conclusion:Patients with cervical spinal stenosis undergoing posterior cervical single-opening spinal canal aneurysm and nerve root canal expansion mini titanium plate internal fixation,bone grafts on the portal axis can better maintain the stability of the posterior column of the cervical spine,improve nerve function,and reduce the occurrence of axial symptoms.The portal axis side of the bone graft neck started activity early,it has the advantages of reduce pain early after surgery and reduce the loss of cervical mobility,allow patients to obtain satisfactory results. |
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