椎体次全切除植骨融合治疗伴间断型OPLL的脊髓型颈椎病  

Cervical spondylosis myelopathy with segmental ossification of posterior longitudinal ligament treated by subtotal vertebrectomy with fusion

作　　者：张宏其[1] 向伟能[1] 肖勋刚[1] 陈静[1] 邓展生[1] 龙文荣[1] 胡建中[1] 王锡阳[1] 

机构地区：[1]中南大学湘雅医院脊柱外科,湖南长沙410008

出　　处：《中国医学工程》2006年第4期344-347,共4页China Medical Engineering

摘　　要：目的 探讨伴间断型后纵韧带骨化症（OPLL）的脊髓型颈椎病的有效治疗方法.方法 自2000年1月～2004年12月,采用椎体次全切除植骨融合术治疗85例伴间断型OPLL的脊髓型颈椎病患者.术前均行X线、MRI检查,其中47例同时做CT检查.对于骨化的后纵韧带与硬膜无明显粘连者,直接咬除骨化的后纵韧带.遇有骨化的后纵韧带与硬膜囊粘连紧密而无法分离时,不强行咬除,采用“漂浮法”以达到椎管减压,重建椎管之目的.结果 85例患者均获4～85个月（平均33个月）的随访,按JOA评分优良率87.1%,术后改善率3.6%～94.2%,平均74.1%.术前未做CT检查的38例患者中,有6例出现硬膜破裂,行CT检查的47例患者中仅2例硬膜破裂.结论 采用“漂浮法”处理伴间断型OPLL的脊髓型颈椎病治疗效果满意;术前CT检查是必需的,以制定手术计划,减少因术前估计不足所致的术中脊髓损伤及脑脊液漏等并发症.[Objective] To explore the effective method of anterior subtotal vertebrectomy and fusion for cervical spondylosis myelopathy with segmental ossification of posterior longitudinal ligament. [Methods] 85 patients of cervical spondylosis myelopathy with segmental ossification of posterior longitudinal ligament were treated by this procedure in our hospital from January of 2000 to December of 2004. Cervical X-ray MRI were evaluated before operation routinely, and 47 patients of them were examined with CT simultaneously.Resect calcicated posterior longitudinal ligament directly, if there was no obvious adhesion between caleicated posterior longitudinal ligament and dura mater sac.When we cannot separate the ealcicated posterior longitudinal ligament from dura mater sac, we can adopt the floating method to obtain the purpose of decompression and reconstruction of vertebral canal. [Results] There were 85 patients, 2 vertebrae were promised in 54 patients, 3 vertebrae were promised in 31 patients.All of the 85 patients had been followed up for a mean period of 33 months（range 4 to 85 months）. According to JOA Sore System the excellent and good rate was 87.3%, and mean recovery rate was 72.6%. Among the 38 patients not examined with CT, there were 6 patients occurred to rupture of the dura mater sac, but only 2 patients happened to rupture of the dura mater in the 47 patients examined with CT. [ Conclusion] The efficaey of floating method operated on cervical spondylosis myelopathy with segmental ossification of posterior longitudinal ligament is with satisfactory, and CT examination is essential before operation. It is helpful to enact operation plan to decrease the complieations of injury of spinal cord and dura mater caused by estimating inadeauatelv before operation.

关 键 词：脊髓型颈椎病 后纵韧带骨化症 间断型 漂浮法 

分 类 号：R681.55[医药卫生—骨科学]