前路多节段椎体次全切除治疗严重颈椎后纵韧带骨化症  

Anterior multilevel corpectomy for the treatment of severe ossification of posterior longitudinal ligament in the cervical spine

作　　者：陈德玉[1] 陈宇[1] 卢旭华[1] 严望军[1] 王新伟[1] 宋滇文[1] 袁文[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海200003

出　　处：《中华医学杂志》2009年第31期2163-2167,共5页National Medical Journal of China

基　　金：基金项目：上海市科委基金（074119629）

摘　　要：目的探讨采用前路多节段椎体次全切除治疗严重颈椎后纵韧带骨化症的适应证、方法及其临床效果。方法2006年4月至2008年3月，25例严重颈椎后纵韧带骨化症患者采用前路多节段椎体次全切除手术进行治疗，年龄42—75岁，平均53．2岁。骨化物分型包括局限型7例，分节型5例，连续型8例，混合型5例；骨化物范围涉及2—4个椎节，平均2．8个椎节；椎管狭窄率50％～97％，平均68．4％。所有患者均通过前路椎体次全切除术，切除骨化后纵韧带减压，并采用钛网植骨钢板固定重建颈椎稳定性。结果本组两椎体次全切除16例，三椎体次全切除9例。随访2～18个月，患者神经功能JOA评分从术前平均9．3（5—12）分提高至术后平均14．2（11～16）分，恢复率22．2％～87．5％，平均63．2％。并发症包括6例脑脊液漏（4例间歇性脑脊液假性囊肿），2例神经根麻痹，1例血肿压迫，1例术后短期四肢肌力下降。结论前路多椎体次全切除治疗严重颈椎后纵韧带骨化症有助于提高此类患者的手术疗效，但手术难度大，风险高。Objective To discuss the surgical indications, outcomes and complications of anterior multilevel corpectomy for the treatment of severe ossification of posterior longitudinal ligament （OPLL） in the cervical spine. Methods Between April 2006 and March 2008, a total of 25 patients （20 males and 5 females, age range： 42 - 75 yr, mean： 53.2 yr） underwent anterior multilevel eorpectomy for severe ossification of posterior longitudinal ligament in the cervical spine. Radiological studies showed that the type of OPLL was distributed as follows ：7 local, 5 segmental, 8 continuous and 5 mixed. The OPLL extended an average of 2. 8 vertebrae （2 - 4） and the stenotic rate of spinal canal was 68.4% （ 50% - 97% ）. After corpectomy and removal of OPLL, titanium mesh cage and anterior plate were employed to restore cervical stability in all patients. Results Among these patients, 16 underwent two-level corpectomy and 9 three-level corpectomy. After a follow-up of 2 - 18 months, the mean JOA score increased from 9. 3 （5 - 12） points pre-operation to 14. 2 （ 11 - 16） points post-operation. The mean improvement rate of neurological status was 63.2% （22. 2% -87. 5% ）. The complications included CSF leakage in 6 cases （intermittent CSF pseudocyst in 4 ）, nerve root palsy in 2, hematoma in 1 and transient neurological deterioration in 1. Conclusion Anterior muhilevel corpextomy can achieve a better clinical outcome in the treatment of severe cervical ossification of posterior longitudinal ligament. But it is technically demanding and carries a higher risk.

关 键 词：骨化 后纵韧带 颈椎 减压术 外科 

分 类 号：R686[医药卫生—骨科学]