颈后路锚钉法单开门结合侧块螺钉内固定治疗颈椎后纵韧带骨化症合并节段性失稳  

Posterior open- door laminoplasty combined with lateral mass screw fixation for cervical ossification of posterior longitudinal ligament( OPLL) and segmental instability

作　　者：唐国军[1] 申佳凡[1] 唐晓军[1] 曹奇[1] 杨铁军[1] 陈亮元[1] 黄新云[1] 

机构地区：[1]南华大学附属第二医院脊柱外科,湖南省衡阳421001

出　　处：《中国矫形外科杂志》2014年第11期976-981,共6页Orthopedic Journal of China

摘　　要：[目的]探讨颈后路锚钉法单开门椎管成形结合侧块螺钉内固定治疗颈椎后纵韧带骨化症合并节段性失稳的临床疗效。[方法]本组31例患者，均诊断为颈椎后纵切带骨化症合并颈椎节段失稳，其中连续型后纵韧带骨化5例，间断型后纵韧带骨化6例，混合型后纵韧带骨化20例；31例均为单节段失稳，其中C3、4失稳7例、C4、5失稳15例、C5失稳8例，C6、7失稳1例。所有患者均行颈后路锚钉法单开门椎管成形结合选择性侧块螺钉内固定治疗。术前和术后,6个8月、末C3次随访时分别对患者视觉疼痛模拟评分（VAS）和JOA评分进行统计学分析。[结果]手术时间120～210min，平均162min；术中出血420～1300ml，平均730ml；28例患者术后症状明显改善，1例术后出现双侧C，神经根麻痹，2例单侧C，神经根麻痹，经脱水、神经营养、高压氧等对症治疗好转后出院。全部病例随访12—60个月，平均30．3个月。31例患者术后3个月、末次随访时VAS评分和JOA评分与术前比较均有显著性差异（P〈0．05）。[结论]颈椎后路锚钉法单开门椎管成形结合侧』火螺钉内[占J定治疗颈椎后纵韧带骨化症合并节段性失稳患者早期疗效满意，其远期疗效尚有待进一步随访总结。[ ObjectiveI To study the clinical outcomes of posterior open -door laminoplasty combined with lateral mass screw fixation on eervieal ossification of posterior longitudinal /igament （OPLL） and segmentalinstability. [Methods] Posterior open- door laminoplasty and lateral mass screw fixation were performed on 31 patients with OPLL and segmental instabili- ty. Among them, continuous - type OPLL was fuund in 5 patients, segmental - type in 6 and mixed - type in 20 patients. In addi- tion, segmental instability was determined at C3,4 in 7 cases, C4,5 in 15 cases, C5,6 in 8 cases and C6,7 in 1 case. Visual analogue scale （VAS） and JOA scores were evaluated respective[y before operation, at 3 months and final follow - up after surgery. [ Re- suits] The operating time was 120 - 210 minutes （ average, 162 minutes） , with blood loss approximately of 420 - 1 300 ml （average, 730 ml） . Clinical symptoms improved in 28 cases, but there were 1 bilateral and 2 unilateral developed C5 nerve root palsy after operation. The symptom improved and recovered su（wessfully based on dehydrater, nerve nutritionalagent, hyper- baric oxygen therapy and symptomatic treatment. The follw - up time was 12 to 60 months with an average of 30. 3 months. Both VAS and JOA scores showed significant difference in all patients at 3 months and final follow - up post - operation compared with before - operation. [ Conclusion] Posterior open - dnor laminoplasty and lateral mass screw fixation has been found to be effec- tive and reliable for OPLL and segmental instahility. There were salisfactory clinical outcomes in early stage, but its long term effect should still be observed.

关 键 词：后纵韧带骨化症 颈椎不稳 椎管成形术 脊髓型颈椎病 

分 类 号：R687.3[医药卫生—骨科学]