剪纸法预测颈椎单开门椎板成形术椎管截面积增量和开门角度的可行性研究OA

Objective To investigate the clinical feasibility of a paper-cutting method to simulate posterior cervical single open-door laminoplasty for predicting postoperative increases in central sagittal canal diameter and cross-sectional area of the spinal canal.Methods Between January 2021 and February 2022,21 patients underwent posterior cervical single open-door laminoplasty,including 12 males and 9 females,aged from 42 to 73 years with a mean of(59.7±9.9)years.There were 18 cas-es of ossification of the posterior longitudinal ligament,3 cases of ligamentum flavum hypertrophy,11 cases of multilevel cervi-cal disc herniation,and 2 cases of developmental spinal stenosis.Cervical CT data were imported into Mimics software to mea-sure preoperative and postoperative spinal canal parameters.Preoperative C3-C7 vertebrae were 3D-printed to simulate open-door laminoplasty,and corresponding spinal canal parameters were recorded.The increase in cross-sectional area of the spinal canal was calculated using the sector area formula(S=nπr2/360).Comparative statistical analysis was performed among pre-operative measurements,postoperative outcomes,simulated open-door parameters,and to verify the clinical feasibility of the paper-cutting method and the formula for calculating the increase in spinal canal cross-sectional area.Results Imaging data were obtained in all 21 patients.Preoperative VAS and JOA scores in the 21 patients were(6.80±1.93)and(10.52±3.80),re-spectively,which significantly improved to(2.42±1.20)and(12.90±4.18)at 12 months postoperatively(P＜0.05).Addition-ally,significant differences were observed in the C3-C7 spinal canal parameters between pre-and post-operation(P＜0.05).At 3 days postoperatively,the C3 opening angle(22.94±5.00)° was significantly smaller than those at the C4(28.67±5.99)°,C5(30.78±5.94)°,C6(29.18±6.55)°,and C7(27.32±6.18)° segments(P＜0.05).Furthermore,the opening width at C3(7.09±0.28)mm and C7(7.47±0.36)mm,as well as the increase in spinal canal cross-sectional area at C3(68.54±17.39)mm2 and C7(63.64±15.82)mm2,were significantly smaller than those at C4(9.17±0.32)mm and(86.84±18.12)mm2,C5(9.31±0.34)mm and(92.80±18.94)mm2,and C6(8.60±0.35)mm and(79.53±17.06)mm2,respectively(P＜0.05).There were no statistically significant differences among the spinal canal parameters measured by the paper-cutting method,the increment of spinal canal cross-sectional area calculated by the formula,and the actual postoperative CT measurements(P＞0.05).Conclusion The extent of laminar opening varies among different cervical levels in posterior cervical single-open door laminoplasty.In clinical prac-tice,the paper-cutting method can be used to plan relevant surgical parameters and may help reduce the incidence of intraop-erative and postoperative complications.