前后路联合手术治疗颈椎后纵韧带骨化症  

The Safety of Combined Posterior-Anterior Approaches for Cervical Ossification of the Posterior Longitudinal Ligament

作　　者：李永军[1] 唐小穗[1] 申勇 于俊叶[3] 

机构地区：[1]北京航天中心医院骨科,北京100049 [2]河北医科大学第三临床医学院脊柱骨科,河北石家庄050051 [3]北京航天中心医院护理部,北京100049

出　　处：《实用骨科杂志》2011年第12期1060-1063,共4页Journal of Practical Orthopaedics

摘　　要：目的回顾性分析研究采用后路单开门椎管成形术联合前路减压植骨融合内固定术治疗68例颈椎后纵韧带骨化症患者的临床及影像学资料,通过分析手术疗效、并发症、适应证评价手术安全性。方法回顾性分析研究本院1999年3月至2010年4月采用前后路联合手术治疗的68例颈椎后纵韧带骨化症患者的临床及影像学资料,所有患者术后随访至少1年,平均18个月;对患者进行术前、术后JOA评分及Nurick分级,采用配对t检验及秩和检验分别对JOA评分及Nurick分级进行统计学分析,评价临床疗效及手术安全性。结果患者JOA评分由术前(6.7±1.1)分提高到术后(15.1±0.6)分,差异有统计学意义(P<0.001,α=0.05),神经功能改善率为(81.5±5.6)%。Nurick分级从术前的(2.8±1.2)级提高到术后的(0.7±0.5)级,差异有统计学意义(P<0.001,α=0.05)。术后神经根麻痹者4例,内固定物松动者1例,临近节段退变加重者3例,无脊髓或神经根永久性损伤、内固定物失败、颈椎后凸畸形等严重并发症发生。结论前后路联合手术治疗颈椎后纵韧带骨化症,可以使脊髓彻底减压,纠正颈椎后凸畸形,维持颈椎稳定性,降低术中损伤脊髓的风险,减少内固定失败及假关节形成等并发症的发生,可获得理想手术疗效,提高了手术安全性。Objective To evaluate the applicability and safety of posterior single open-door vertebral canaloplasty combined with anterior decompression,fusion and internal fixation for the management of cervical ossification of the posterior longitudinal ligament,the authors retrospectively reviewed 68 consecutive procedures of this type performed at their respective institutions and studied the surgical effects and surgical complications,surgical indications.Methods Retrospectively analyzed 68 patients with the disease of cervical ossification of the posterior longitudinal ligament operated by combining posterior-anterior approachs surgical treatment from March in 1999 to April in 2006,All the patients were followed up minimum of 1 years（mean 18 months）.JOA scores system and Nurick grading system were used to evaluate the effect and safety of the treatment.Results JOA scores were improved from preoperative（6.7±1.1） to postoperative（15.1±0.6）,T-test was used to compare preoperative and postoperative JOA scores.The statistical results were significantly different（P0.001,α=0.05）.The improvement rate of posterior-anterior unites to cure the cervical ossification of posterior longitudinal ligament was（81.5±5.6）%;Nurick grading were improved from（2.8±1.2） to（0.7±0.5）,and were statistically analyzed with the method of rank-sum test of the ordered Variable data.The statistical results were significantly different（P0.001,α=0.05）.Approaching segment degeneration increased in 3 cases.There were no cases of spinal cord or nerve root abiding injury,strut graft extrusion,or anterior plate or screw fracture,or cervical kyphosis,and other severe complacations.Conclusion The combined anterior-posterior decompression and instrumentation procedure provides the thoroughly decompression for cervical spinal cord,corrects cervical kyphosis,and keeps the stabilization of the cervical spine.Furthermore,it lowers the rate of injuring spinal cord,poor prostecdtive efficacy,and diminishs anterior plate failure o

关 键 词：后纵韧带骨化症 椎管成形术 手术安全性 

分 类 号：R681.55[医药卫生—骨科学]