髓内外减压在有脊髓信号改变的颈椎后纵韧带骨化症中的疗效分析  

Efficacy of intramedullary and extramedullary decompression on cervical ossification of the posterior longitudinal ligament with spinal cord signal change

作　　者：焦根龙[1] 李志忠[1] 潘永勤[1] 周志刚[1] 孙国栋[1] 卲建立 周霖[1] 

机构地区：[1]暨南大学附属第一医院骨二科,广东广州510632

出　　处：《南方医科大学学报》2013年第9期1382-1385,1389,共5页Journal of Southern Medical University

基　　金：国家卫生部科技局项目(W2012ZT12)

摘　　要：目的观察不同手术方式在治疗有脊髓信号改变的颈椎后纵韧带骨化症（OPLL）的疗效，为临床选择手术方式提供依据。方法随访自2005年1月~2011年 1月治疗的有脊髓信号改变OPLL患者38例，其中采用颈前路减压植骨内固定术的A组10例，采用颈后路单开门减压植骨内固定术的B组12例，采用后路脊髓脊膜切开减压松解、单开门减压植骨内固定术的C组16例。随访时用JOA评分法进行评价，记录术前、术后评分并计算改善率，定期复查X线、CT或 MRI，统计并发症。结果术后12月3组的改善率分别为52.39%、55.15%、60.32%，C组的改善率高于A、B组，3组间比较，有统计学差异（P〈0.05）；术后12月3组JOA评分分别为13.54±0.56、13.56±1.26、14.70±1.41，术后各组JOA评分较术前均明显提高（P〈0.05），B、C组评分高于A组，近期疗效C组优于A、B组。A组1例出现瘫痪和脑脊液漏，B、C组各有1例术后仍有上肢麻痹，C组术后恢复时间短，很快进入平台期，无出现严重并发症。结论经颈后路髓内减压松解、椎管成型、侧块钉内固定术在治疗有信号改变的颈椎OPLL患者是有效的治疗方法，能较快达到恢复的平台期，缩短康复时间。Objective To evaluate the clinical effect of different surgical approaches for treating cervical ossification of the posterior longitudinal ligament （OPLL） with spinal cord signal change. Methods Thirty-eight patients with OPLL with spinal cord signal change were treated from January 2005 to January 2011. Surgical removal via an anterior approach or partial decompression was performed in 10 cases （group A）, posterior approach open-door laminoplasty with decompression, bone grafting and internal fixation was performed in 12 cases （group B）, and opening the cervical spinal meninges to relieve the pressure was performed in 16 cases （group C） on the basis of the procedures in group B. All the patients were followed up and the pre- and postoperative JOA scores, improvement ratio and inter-body implant fusion were evaluated. Imaging examinations including X-rays, CT and MRI were also performed pre- and postoperatively, and the surgical complications were recorded. Results At 12 months postoperatively, the mean improvement rates in groups A, B, and C were 52.39%, 55.15%, and 60.32%, respectively, with the mean JOA scores of 13.54 ± 0.56, 13.56 ± 1.26, and 14.70 ± 1.41, respectively. The JOA scores and improvement rates significantly increased after the surgeries. One patient in group A became paraplegic after the operation with cerebrospinal fluid leakage, and one patient in group B and one in group C reported numbness of the upper limb. Group C showed a shorter postoperative recovery time without severe complications. Conclusion Posterior open-door laminoplasty, decompression, bone grafting and internal fixation can be an effective approach for treatment of cervical OPLL with spinal cord signal change and requires shorter rehabilitation time after the operation.

关 键 词：颈椎 后纵韧带骨化症 脊髓信号 髓内外减压 

分 类 号：R687.3[医药卫生—骨科学]