颈椎后纵韧带骨化症病变范围涉及第二颈椎时后路减压与伸肌重建策略  

The strategy of posterior decompression and re-establishing the insertion of extensor for ossification of posterior longitudinal ligament involved in C2

作　　者：王伟[1] 高成杰[1] 任龙喜[2] 

机构地区：[1]解放军第二五二医院脊柱外科,保定071000 [2]北京市垂杨柳医院骨科

出　　处：《中华外科杂志》2008年第18期1419-1423,共5页Chinese Journal of Surgery

摘　　要：目的探讨颈椎后纵韧带骨化症（OPLL）病变范围涉及第二颈椎时行后路减压和伸肌重建的方法。方法2002至2006年治疗OPLL病变范围涉及C2者10例，均行保留颈后方韧带复合体、重建颈伸肌群附着点、单开门颈椎板成形术，椎板成形减压范围C2～C7。测量手术前后CT片上C2有效椎管矢状径，计算减压程度；测量手术前后X线片上C2～C7角，对比生理曲度维持情况；记录手术前后和随访时JOA评分。结果平均随访14个月，C2有效椎管矢状径术前平均5．6mm（4．0～8．8mm）、术后平均13．4mm（10．0～18．2mm）（与术前相比P〈0．01）；中立位C2～C7角术前6．5°（-2°～12°）、术后7．4°（3°～14°）、末次随访7．0°（2°～15°）（与术前相比P〉0．05）；JOA评分术前6～12分（平均9．6分）、术后8～14分（平均10．9分）、末次随访10～17分（平均13．2分）（与术前相比P〈0．05）。结论保留颈后方韧带复合体重建颈伸肌群附着点单开门颈推板成形术，对病变范围涉及第二颈椎的OPLL是适宜的手术方法，可以达到减压彻底、维持颈椎生理曲度的目的。Objective To investigate an approach of posterior cervical spinal canal decompression and re-establishing the insertion of extensor, aim at the ossification of the posterior longitudinal ligament （OPLL） involved in C2. Methods From 2002 to 2006, 10 patients with OPLL involved in C2 underwent open-door laminoplasty, with the posterior cervical ligamentous complex and the insertion of extensor reconstructed on C2, were reviewed retrospectively. The range of decompression was from C2 to C7. The sagittal diameter of C2 vertebral canal, alignment of the cervical spine （ C2-C7 angle）, and JOA score before and after operation were contrasted respectively. Results All patients were follow-upped, average 14 months. Before the operation, the average sagittal diameter of C2 vertebral canal was 5.6 ram（4-8.8 mm）, JOA score was 9.6 scores （6-12 scores） , C2-C7 angle was 6. 5° （- 2°-12°）. After the operation, the average sagittal diameter of C2 vertebral canal was 13.4 mm（ 10-18, 2 mm, P 〈0. 01 ）, JOA score was 10. 9 scores （8-14 scores） and the C2-C7 angle was 7.4° （3°-14°） in earlier. Finally, the JOA score was 13.2 scores（ 10-17 scores,P 〈0. 05 ）, and the C2-C7 angle was 7.0° （ 2°-15° ,P 〉 0. 05 ） at last. Conclusions The open-door laminoplasty, with an approach of the posterior cervical ligamentous complex and the insertion of extensor reconstructed, is an appropriate method for treating OPLL involved in C2. This process keeps the cervical curve in a better way, and decompresses the spinal canal effectively.

关 键 词：骨化 后纵韧带 枢椎 减压 重建 

分 类 号：R686[医药卫生—骨科学]