BACKGROUNDThe incidence of lumbar tuberculosis is high worldwide, and effective treatment is a continuing problem.AIMTo study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis.METHODSThe C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) score, oswestry disability index (ODI) and American Spinal Injury Association (ASIA) grade were recorded and analysed pre- and postoperatively.RESULTSThe CRP level and ESR returned to normal, and the VAS score and ODI were decreased at 3 mo postoperatively, with significant differences compared with the preoperative values (P < 0.01). Neurological dysfunction was relieved, and the ASIA grade increased, with no adverse events.CONCLUSIONThe multitrack, multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.

In order to investigate the clinical effect of unidirectional barbed continuous suture and continuous edge stitching with ab-sorbable thread in accelerated rehabilitation of total knee arthroplasty.A total of 106 patients who underwent total knee replacement surgery in Handan Central Hospital from March 2020 to June 2022 were selected and divided into control group(52 cases)and obser-vation group(54 cases).In the control group,the incision was continuously hemmed and sutured with absorbable wire,and in the ob-servation group,the incision was continuously sutured with one-way barbed wire.The differences in suture time,operation time,blood loss,postoperative hospital stay,knee function,knee range of motion(ROM)and complications were compared between the two groups.The results show that the suture time of observation group is shorter than that of control group(P<0.05),and the incidence of subcutaneous ecchymosis and needle puncture is lower than that of control group(P<0.05).There are no significant differences in operation time,mean blood loss,mean length of hospital stay,hospital for special surgery knee score(HSS),Rasmussen score,knee ROM,incidence of incision redness,incision infection and delayed incision healing between the two groups(P>0.05).It is concluded that Unidirectional barbed continuous suture can shorten the suture time,reduce the incidence of postoperative subcutaneous ecchymosis and needle puncture,and has certain advantages in accelerating the rehabilitation of total knee replacement incision suture.

探讨用Pie-crusting技术松解内侧副韧带术后制动与否对内侧韧带愈合的影响.自2016年11月—2018年10月,膝关节镜手术中应用Pie-crusting技术(由外向内)松解内侧副韧带患者53例,其中病历号尾数为单数的患者(A组)术后给以膝关节可调支具固定制动;尾数为双数的患者(B组)术后未进行支具固定制动.术后6周做MRI(magnetic resonance imaging)检查两组病例膝关节内侧副韧带愈合情况;膝关节外翻应力X片测量膝关节内侧间隙;比较患者随访时的主观症状,评估Ly-sholm主观功能评分.平均随访时间为(28.75±4.028)个月(24～36个月).术中通过松解内侧副韧带,两组病例均达到内侧理想操作空间,术后6周时组间比较术前术后膝关节内侧间隙无统计学意义(P>0.05);两组病例随访末次Lysholm功能评分均较术前提高,两组间无统计学意义(P>0.05);两组患者6周时MRI显示内侧副韧带均已愈合.应用关节镜处理膝关节内侧半月板损伤时,针对膝关节内侧间室狭窄的病例可选择Pie-crusting技术(由外向内)松解内侧副韧带,以其达到扩大操作空间,改善观察视野的目的,术后膝关节制动与否对内侧副韧带的愈合无影响.

为研究椎间孔镜技术联合选择性神经根阻滞治疗腰椎间盘突出症的疗效.回顾性分析本院2015年1月—2019年12月采用椎间孔镜技术联合选择性神经根阻滞治疗120例腰椎间盘突出症患者的临床资料.术后随访6个月,观察并记录术中情况、并发症发生情况及术后6个月采用Macnab量表评价手术疗效.结果表明:120例患者均顺利完成手术,平均术中出血量(32.34±12.45)mL,平均手术时间(64.14±16.42)min,术后卧床时间(1.23±0.82)d,平均住院时间(3.34±1.12)d;120例患者均获得随访,术后6个月优良率为90.83％.120例患者术后并发症总发生率为8.33％,其中术侧感觉迟钝与腰痛复发各3例、手术部位再突出与损伤血管丛各2例.椎间孔镜技术联合选择性神经根阻滞治疗腰椎间盘突出症的近期疗效可靠,术后并发症发生率低,值得临床推广.

目的 探讨颈椎前后路减压手术治疗男性脊髓型颈椎病伴勃起功能障碍患者的临床效果.方法 回顾性分析2018年7月-2020年3月邯郸市中心医院骨科采用颈椎前后路手术治疗23例男性脊髓型颈椎病伴勃起功能障碍患者的临床资料.手术前和随访时,采用JOA评分评估患者脊髓功能状态和IIEF-5评分评估勃起功能障碍情况.计算JOA评分和IIEF-5评分的恢复率并进行相关分析,比较两种术式间IIEF-5评分恢复率的差异.结果 23例患者均获得随访,平均12.3(6-20)月.随访时,JOA评分和IIEF-5评分均较术前显著改善,且有统计学差异(P＜0.05).IIEF-5评分恢复率与JOA评分恢复率之间存在明显的相关性(P=0.034),而颈椎不同术式间IIEF-5评分恢复率差异无统计学意义(P=0.821).结论 颈椎前后路减压手术除可改善脊髓功能外,还可改善勃起功能障碍.勃起功能障碍的改善与脊髓功能的恢复相关,但与手术入路无关.

为研究微创经皮椎弓根内固定术(minimally invasive percutaneous pedicle screws osteosynthesis,MIPPSO)对胸腰椎骨折患者功能障碍指数、伤椎高度以及疼痛程度的影响,回顾性分析2018年10月—2020年10月期间进行微创经皮椎弓根内固定术治疗的53例胸腰椎骨折患者临床资料,观察记录所有手术患者创面愈合时间、手术时间、术中出血量;比较患者术前、术后的功能障碍指数(Oswestry disability index,ODI)、疼痛程度(visual analogue scale,VAS)以及伤椎高度与Cobb角.结果表明:53例患者胸腰椎手术均已完成.其中创面愈合时间为(7.34±1.23)d,手术时间为(83.98±6.22)min,术中出血量为(66.45±5.11)mL.术后6 d与术后10个月,ODI、VAS评分均明显低于术前(P<0.05).术后6 d与术后10个月,患者伤椎前缘高度均明显高于术前(P<0.05),但Cobb角度明显均低于术前(P<0.05).胸腰椎骨折患者进行经皮椎弓根内固定术治疗,能够改善患者腰椎功能障碍,同时减少术中出血量,缩短手术时间,促进创面快速愈合,并有效减轻术后机体疼痛,值得临床应该与推广.

针对单开门椎管扩大成形术中椎板门轴侧断裂伴移位的问题,对不同门轴处理方式的术后疗效进行研究.通过回顾性分析,将2013年5月—2018年9月在邯郸市中心医院接受单开门椎管成形钛板固定术治疗的319例脊髓型颈椎病患者纳入研究中,其中有63例患者术中发生门轴断裂伴椎板移位,根据处理方式将其分为两组:重建组(35例),对椎板进行叠瓦状重建及钛板固定治疗;切除组(28例),将断裂并移位的椎板切除.记录并比较两组患者术中的相关指标,观察患者神经功能(JOA评分)、颈椎曲度指数(cervical curvature index,CCI)、颈后肌群横截面积变化及轴性症状的发生情况.结果表明:在手术时间及术出血量上,两组比较无显著统计学差异(P>0.05).术后两组的颈后肌群横截面积较术前均有明显减小(P<0.05),但重建组横截面积减小程度明显低于切除组(P<0.05).重建组术后CCI获得较好维持(P>0.05),切除组的CCI较术前出现明显丢失(P<0.05);至末次随访时,组间比较有显著统计学差异(P<0.05).两组患者JOA评分均有显著升高(P<0.05),组间比较无显著统计学差异(P>0.05).术后重建组有8.6％的患者出现轴性症状(3/35),切除组为21.3％(6/28),具有显著统计学差异(P<0.05).术后3个月时,重建组81.6％(31/38)的断裂门轴获得骨性融合,至术后6个月时,有94.7％(36/38)的断裂门轴获得骨性融合.可见,对于门轴断裂伴椎板移位的患者,采用叠瓦状椎板重建联合钛板固定及切除椎板均不会影响术后神经功能的恢复,但椎板重建更有利于颈椎曲度的维持并减轻颈后肌群的萎缩,从而降低轴性症状的发生.

颈椎棘突是颈后肌群重要的附着点,在全椎板减压术或单开门椎管成形术中极易被破坏.为明确重建伸肌附着点及保留C7棘突开槽式减压在治疗脊髓性颈椎病的临床疗效,分析了2017年1月—2018年7月81例多节段脊髓型颈椎病患者在邯郸市中心医院接受单开门椎管扩大成形术治疗的情况,其中70例获得完整临床随访.根据手术方法将其分为两组:观察组(37例),单开门术中采用伸肌附着点重建和保留C7棘突开槽式减压治疗;对照组(33例),行常规单开门椎管成形钛板固定术治疗.记录手术时间及术中出血量,观察术后患者神经功能改善、颈椎曲度指数(cervical curvature index,CCI)改变、颈后肌群横截面积变化及轴性症状(axial symptoms,AS)的发生情况.结果表明:观察组在手术时间及术中出血量上明显高于对照组(P<0.05);在椎板开门角度及脊髓漂移距离上,两组比较无显著统计学差异(P>0.05);术后两组患者的JOA评分较术前有显著升高(P<0.05),两组在神经功能恢复率上无显著统计学差异(P>0.05).观察组在CCI及颈后肌群横截面积上与术前比较无显著统计学差异(P>0.05),对照组的上述数值较术前明显减小(P<0.05).观察组轴性症状发生率为8.1％(3/37),对照组为21.2％(7/33),具有显著统计学差异(P<0.05).可见,在单开门椎管成形术中,重建伸肌附着点及保留C7棘突开槽式减压会增加手术时间,但术式的改进可以更好地维持颈椎曲度,减轻颈后肌群萎缩并降低术后轴性症状的发生.

氨甲环酸(tranexamic acid,TXA)作为抗纤溶抑制剂可以减少出血现已广泛应用于全膝关节置换术(total knee arthroplasty,TKA).为了观察多剂量静脉联合局部应用TXA的安全性及有效性.采用回顾性分析,选取接受初次单侧TKA的175例骨性关节炎的患者.将患者分为4组,第1组关节囊关闭后关节腔灌注1 g TXA;第2组止血带加压前静脉应用1 g氨甲环酸;第3组止血带加压前、松止血带后静脉各输注1 g TXA;第4组在止血带加压前、松止血带后、第二次剂量后3 min静脉各输注1 g TXA,关节囊关闭后关节腔灌注1 gTXA.比较各组的血红蛋白下降值、总失血量、隐性失血量、引流量、输血率,深静脉血栓、肺栓塞发生率.结果 显示:多剂量静脉联合局部组患者血红蛋白下降值、总失血量、引流量、隐性失血量均低于其余三组,差异有统计学意义(P＜0.05).多剂量静脉联合局部组术后无输血患者,优于其余三组,差异有统计学意义(P＜0.05).四组术后均无深静脉血栓事件发生.研究结果表明,多剂量静脉联合局部应用TXA是安全有效的.

目的:探讨颈椎侧块螺钉固定术后颈椎曲度大小与与临床疗效的关系.方法:2018年02月～2019年10月纳入65例脊髓型颈椎病患者进行研究,均采用全椎板减压侧块螺钉固定术,术后测量颈椎曲度,根据大小将其分为两组:A组(29例),颈椎曲度正常(7mm≤弧弦距≤17mm);B组(36例),颈椎曲度减小(00.05).A组轴性症状VAS评分显著高于B组(P<0.05).A组有3例(7.9％)患者发生C5神经麻痹,B组有4例(12.1％),两组在C5神经麻痹发生率上无显著统计学差异(P>0.05).结论:侧块螺钉固定术后颈椎曲度变小临床常见,该现象不会影响神经功能的恢复及C5神经麻痹的高发,但会加重患者的轴性症状.

为评价在加速康复理念下初次全膝关节置换术中应用倒刺线缝合关节囊较可吸收线的优势,回顾性分析2018年7月至2019年7月邯郸市中心医院骨五科行初次全膝关节置换术的85例患者,其中倒刺线组41例、可吸收线组44例,比较两组在切口缝合时间、切口并发症、术后关节功能方面的差异.结果 表明:倒刺线组关节囊缝合时间、总缝合时间与可吸收线组相比显著缩短,差异有统计学意义(P =0.003、P=0.035);倒刺线组皮下缝合时间、皮肤缝合时间与可吸收线组相比,差异无统计学意义(P =0.100、P=0.740);倒刺线组切口皮下血肿率低于可吸收线组,倒刺线组切口并发症发生率低于可吸收线组,差异无统计学意义(P=1.0);倒刺线组术后膝关节活动度与可吸收线组相比,差异无统计学意义(P =0.961);术后3月和末次随访两组KSS(Knee Society score)(膝关节协会评分)临床评分及功能评分均较术前明显改善,差异有统计学意义(P＜0.05),两组组间及组内比较差异无统计学意义(P＞0.05).倒刺线缝合关节囊手术时间短,切口并发症少,术后关节功能良好,有利于加速康复,推荐使用.

目的:探讨椎板分区切除法脊髓减压内固定术在治疗胸椎黄韧带骨化症(thoracic ossification of the ligamentum flavum,T-OLF)的疗效性及安全性.方法:回顾性分析58例T-OLF病人的临床资料,根据手术方法将其分为:A组(25例),根据黄韧带的解剖学特点及与椎板的毗邻关系,在椎板后方进行区域划分后,采用椎板分区减压、逐节切除、脊髓减压内固定术治疗;B组(21例),采用椎板分层薄化法减压内固定术治疗.记录2组手术时间、出血量及并发症发生情况,观察术后病人神经功能恢复及局部后凸角变化情况.结果:2组手术时间和术中出血量差异均无统计学意义(P>0.05).2组术后JOA评分均较术前有明显升高(P<0.05));A组神经功能改善率(72.2±14.8)％,B组为(73.1±15.2)％,差异无统计学意义(P>0.05).2组术后局部Cobb角均较术前有明显改善(P<0.01),不同时间点组间比较差异均无统计学意义(P>0.05).A组病人脑脊液漏发生率12.00％与B组的23.80％差异有统计学意义(P<0.05).结论:椎板分区切除法脊髓减压内固定可减少椎管内侵袭性操作,硬膜撕裂的发生率低,安全性相对高,内固定植入有利于术后胸椎稳定性更好维持.

Objective:To investigate the relationship between cervical curvature (CC) and spinal drift distance after laminectomy with lateral mass screw fixation and the influence on the operative effect.Methods:From October 2016 to December 2017, a total of 85 patients with cervical spondylotic myelopathy (CSM) underwent laminectomy with lateral mass screw fixation in handan central hospital, and 78 patients were followed up completely.After the operation, according to the Harrison method, they were divided into 2 groups(Group A (43 cases, 0°≤CC≤16.5°); Group B (35 cases, CC>16.5°)). The spinal drift distance, nerve recovery, axial symptoms and C5 palsy in the groups were recorded and analyzed.Results:The CC was 8.5°±3.8° in group A and 19.6°±3.0° in group B ( t=14.071, P=0.000). The laminectomy width in group A was (22.1±1.7) mm, in group B was (21.8±1.5) mm, the difference between the two groups was not statistically significant ( P>0.05). The distance of spinal cord backward movement was (1.7±0.4) mm in group A and (3.2±0.7) mm in group B. There was significant difference between the two groups ( t=11.879, P<0.001). At the end of one year, the improvement rates of nerve function in the two groups were (63.3±13.1)% and (65.1±13.9)% respectively, there was no significant difference between the two groups ( t=0.587, P=0.559). The VAS score of group A was (5.2±1.3) at one week and (3.5±0.6) at one month after operation, and that of group B was (3.8±0.8) and (2.4±0.4) respectively.There were statistically significant differences between groups at different time points ( t=5.567, P<0.001; t=9.289, P<0.001). The incidence of C5 paralysis was 7.0% (3/43) in group A and 11.4% (4/35) in group B. There was no significant difference between the two groups ( P>0.05). Conclusion:The greater the curvature of cervical spine is, the more fully the spinal cord moves backward.The loss of curvature of cervical spine is related to the occurrence of axial symptoms.The curvature of cervical spine is not related to the recovery of nerve function and the occurrence of C5 nerve paralysis.

目的:观察单开门微型钛板固定联合保留C7棘突开槽式椎板减压及颈后伸肌附着点重建术在治疗脊髓型颈椎病(CSM)的临床效果.方法:回顾性分析32例接受手术治疗的多节段CSM(M-CSM)患者,采用单开门微型钛板固定联合保留C7棘突开槽式椎板减压及颈后伸肌附着点重建术治疗,观察患者手术时间、术中出血量及椎板开门角度,术后神经功能改善、颈椎曲度指数(CCI)、颈后肌群横截面积变化及轴性症状(AS)的发生情况,以日本矫形外科协会(JOA)评分评估患者手术前后神经的功能状态.结果:患者的平均手术时间(131.7±26.9)min,术中出血量(313.6±51.2)ml,椎板开门角度(51.90±8.30)°;所有患者均获得超过1年的临床随访,平均随访时间(21.2±8.3)个月;在JOA评分中,术前(7.9±2.4)分,术后3个月时(12.7±3.3)分,末次随访时(13.6±3.7)分,手术前后比较差异有显著统计学意义(F=29.711,P<0.05);神经功能改善率(62.6±11.2)％.CCI术前为(16.4±3.9)％,术后3个月时为(13.7±3.2)％,末次随访时减小为(14.9±3.6)％,其差异无统计学意义.颈后肌群横截面积由术前的(35.9±7.3)cm2减小为术后1年时的(32.5±6.7)cm2,差异亦无统计学意义.轴性症状发生率为12.5％.结论:对于累及C7水平的M-CSM,采用单开门微型钛板固定联合保留C7棘突开槽式椎板减压及颈后伸肌附着点重建,可以显著促进神经功能恢复,减轻颈后肌群萎缩,显著降低术后轴性症状的发生.

Background : This study aims to assess the efficacy of four hollow nail rhombic fixation (FHNRF) for the treatment of patients with femoral neck fractures (FNF). Methods : A literature search in MEDLINE, Scopus, Web of Science, EMBASE, Cochrane Library, ProQuest, Thesis and Dissertation Catalog, Cumulative Index to Nursing and Allied Health Literature, and China National Knowledge In­frastructure will be performed from inception through February 29, 2020. This study will not apply limitations to the language and publication date. All potential randomized controlled trials (RCTs) that identify the efficacy and safety of FHNRF for the treatment of patients with FNF. Two contributors will separately examine searched records, extract essential data, and assess study quality using Cochrane risk of bias tool. Any opposition between two authors will be settled by a third contributor. We will employ RevMan 5.3 software for statistical analysis. Discussion : This study will summarize high quality RCTs to assess the efficacy and safety of FHNRF for the treatment of patients with FNF. It will help to determine whether or not FHNRF is effective and safety for the treatment of patients with FNF. Systematic review registration CRD42020168378.

目的 观察脊髓型颈椎病患者全椎板减压侧块螺钉固定术后颈椎曲度的变化,并探讨其对临床疗效的影响.方法 行全椎板减压侧块螺钉固定术治疗的脊髓型颈椎病患者76例,采用Bordon法测量术后颈椎曲度并将其分为A组(0<颈曲值<7 mm)41例、B组(7 mm≤颈曲值≤17 mm)35例.观察两组椎板切除宽度、脊髓后移距离、神经功能恢复情况(采用JOA评分评价)、轴性症状及C5神经麻痹发生情况.结果 A组椎板切除宽度为(19.9±1.5)mm,B组为(20.6±1.7)mm,两组比较,P>0.05;A组脊髓后移距离为(1.8±0.4)mm,B组为(2.7±0.6)mm,两组比较,t=7.792,P<0.01.两组术后3个月及末次随访时JOA评分均较术前升高(P均<0.05);但不同时间点组间比较,P均>0.05.A组神经功能恢复率为63.2％ ±12.8％、B组为64.5％ ±13.7％,两组比较,P>0.05.术后1个月时,A组轴性症状严重程度高于B组(Z=-2.384,P=0.017).两组C5神经麻痹率比较,χ2=0.011,P=0.918.结论 脊髓型颈椎病患者全椎板减压侧块螺钉固定术后超过一半的患者出现颈椎曲度变小,颈椎曲度变小可促使脊髓后移距离变短、轴性症状严重程度加重,而与神经功能的恢复及C5神经麻痹无明显关联.

Background: Published trials reported that high-energy extracorporeal shock wave therapy (HEEPSWT) can effectively treat early stage femoral head osteonecrosis (ESFHO). However, their results are still inconsistent. Thus, this study will systematically and comprehensively explore the effectiveness and safety of HEEPSWT for ESFHO. Methods: We will retrieve the electronic databases of Cochrane Library, EMBASE, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, VIP database, and China National Knowledge Infrastructure from inception to the present. All randomized controlled trials that focusing on the effectiveness and safety of HEEPSWT for ESFHO will be considered. Two researchers will undertake literature selection, information collection, and risk of bias evaluation separately. If disagreements occur, we will invite a third researcher for consultation and a final decision will be made. Cochrane risk of bias tool, and Grades of Recommendation, Assessment, Development and Evaluation will be utilized to assess the risk of bias and quality of evidence, respectively. We will perform statistical analysis using RevMan 5.3 software. Results: This study will provide a detailed summary of exist evidence related to the effectiveness and safety of HEEPSWT for ESFHO. Conclusion: The results of this study synthesize the evidence regarding the HEEPSWT for ESFHO, which may help to guide clinical management in the future. Systematic review registration: INPLASY202060055.

目的 比较经皮椎体成形术(PVP)治疗年龄＜80岁与年龄≥80岁老年骨质疏松性椎体压缩骨折临床疗效.方法 回顾性分析自2015-10-2018-09采用PVP治疗的100例老年骨质疏松性椎体压缩骨折,年龄＜80岁者81例(老年组),年龄≥80岁者19例(高龄组).比较2组手术时间、骨水泥注入量、并发症情况、术后7d及6个月疼痛VAS评分及ADL评分.结果 2组手术时间、骨水泥注入体积比较差异无统计学意义(P＞0.05).高龄组并发症情况较老年组优,差异有统计学意义(P＜0.05).2组术后7天、术后6个月疼痛VAS评分、ADL评分比较差异无统计学意义(P＞0.05).结论 PVP可以有效缓解80岁及以上的骨质疏松性椎体压缩骨折疼痛,术后恢复满意.

观察颈椎后路限制性椎板减压术后颈椎曲度大小与颈髓后移距离的关系及对手术疗效的影响.2016年1月至2017年12月,有87例颈椎曲度正常的脊髓型颈椎病患者在邯郸市中心医院接受限制性椎板切除术治疗,其中有74例获得完整的临床随访.术后根据harrison方法测量颈椎曲度并将其分为:A组,颈椎曲度变减小(0°≤颈椎角≤16.5°);B组,颈椎曲度正常(颈椎角>16.5°).术后观察两组患者神经功能改善情况、脊髓后移距离、颈椎活动度(range of motion,ROM)、轴性症状严重程度及C5神经麻痹发生情况.在平均23.8个月的临床随访中,36例患者(A组)的颈椎曲度变小(48.6％),平均颈椎角为9.7°±5.3°;38例患者(B组)颈椎曲度维持正常(51.4％),颈椎角为18.7°±4.6°,两组颈椎曲度比较具有显著统计学差异(P<0.05);A组椎板切除宽度为(18.5±2.1)mm,B组为(17.9±1.8)mm,差异无统计学意义(P>0.05);A组脊髓后移距离为(1.8±0.5)mm,B组为(2.6±0.8)mm,具有显著统计学意义(P<0.05).术后两组患者的ROM较术前无明显减小(P>0.05),日本矫形外科协会(Japanese Orthopaedic Association,JOA)评分均较术前有明显升高(P<0.05),组间比较无显著统计学差异(P>0.05);A组轴性症状严重程度明显重于B组(P<0.05);A组有3例(8.3％)患者发生C5神经麻痹,B组有4例(10.5％),两组比较无统计学差异(P>0.05).以上结果表明,限制性椎板切除术后仍有近半数的患者出现颈椎曲度丢失,颈椎曲度减小使得脊髓后移距离缩短并增加轴性症状的严重程度,而颈椎曲度与神经恢复效果及C5神经麻痹无明显关联.

目的 观察颈后路单开门微型钛板固定联合伸肌附着点重建在治疗累及C2节段脊髓型颈椎病的临床疗效.方法 回顾性分析2014年3月至2017年1月接受手术的累及C2节段脊髓型颈椎病患者46例的临床资料,根据手术方式将其分为两组,对照组(n=21)采用传统单开门椎管扩大成形钛板固定术,观察组(n=25)采用单开门椎管扩大成形钛板固定+伸肌群附着点重建术治疗.术后观察患者的日本骨科协会(JOA)脊髓损害评分、颈椎活动度、颈椎曲度、颈后肌群截面积和轴性症状发生情况.结果 两组手术时间和术中出血量无显著性差异(t<0.863,P>0.05).两组术后JOA评分均显著升高(F>24.961,P<0.001),组间无显著性差异(t<0.282,P>0.05).两组术后颈椎总活动度无明显变化(F<0.931,P>0.05).对照组术后颈椎中立位曲度明显减小(F=8.241,P<0.01),观察组则无明显改变(F=2.705,P>0.05).对照组术后颈后肌群截面积减小(t=2.678,P<0.05),观察组术后无明显改变(t=0.854,P>0.05).观察组轴性症状发生率低于对照组(Z=-2.192,P<0.05).结论 椎管成形术可解除C2节段脊髓压迫,促进神经功能的恢复;结合伸肌附着点重建可更好维持颈椎曲度,减轻颈后肌群萎缩,降低轴性症状发生.