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目的 比较单开门椎板成形术和椎板切除并侧块螺钉内固定术治疗颈椎后纵韧带骨化症(OPLL)的疗效及术后并发症发生情况,并探究颈椎曲度和矢状面平衡对疗效的影响. 方法 回顾性分析2005年1月—2013年12月在西安交通大学附属红会医院行手术治疗的455例多节段OPLL患者资料,其中231例行椎板成形术(A组),224例行椎板切除并侧块螺钉内固定术(B组),手术范围均为C3~7.记录2组患者一般资料及术后并发症发生情况.比较术后各随访时间点的C2~7Cobb角、颈椎曲度指数(CCI)、C2铅垂线至C7后上缘的距离(C2~7SVA)、日本骨科学会(JOA)评分、视觉模拟量表(VAS)评分和颈椎功能障碍指数(NDI). 结果 所有患者均获随访,平均随访31.2(27~38)个月.术后24个月,2组C2~7Cobb角和CCI均较术前明显减小,但2组间差异无统计学意义(P > 0.05);A组C2~7SVA较术前明显增高,B组C2~7SVA无明显变化,2组间相比差异有统计学意义(P 0.05);VAS评分在术后1个月、3个月、6个月时A组低于B组,差异有统计学意义(P 0.05);NDI在术后1个月、3个月时A组低于B组,差异有统计学意义(P 0.05).共有34例患者发生C5神经根麻痹,其中A组中有11例,B组中有23例,差异有统计学意义(P 0.05);C2-7SVA of group A showed no statistical difference with group B (P > 0.05) within 1 month,but higher than group B at each follow-up point afterwards(P < 0.05). JOA score,VAS score and NDI of 2 groups were significantly ameliorated at 24 months(P 0.05);VAS score of group A was lower than that of group B(P 0.05);NDI of group A was lower than that of group B(P 0.05). A total of 34 patients suffered from C5palsy,11 in group A and 23 in group B,with statistical difference(P < 0.05). Conclusion Although laminoplasty is inferior to laminectomy combined with lateral mass screw fusion in maintaining sagittal balance,but both can acquire similar neurological recovery. The axial pain after laminoplasty is milder than laminectomy combined with lateral mass screw fusion in the short term,but both are similar in the long term. The incidence of C5palsy after laminoplasty is lower than that after laminectomy combined with lateral mass screw fusion,which will recover in 6 months.