C2穹顶下减压术及C2单开门椎管成形术治疗颈椎高位后纵韧带骨化症的比较研究  

A clinical Study of C2dome-like expansive laminoplasty and C2 expansive open-door laminoplastyinupper cervical ossification of the posterior longitudinal ligament

作　　者：李万里[1] 余成诚 吴依楠 李方财[1] 马骏[1] 陈其昕[1] 陈维善[1] Li Wanli;Yu ChengCheng;Wu Yinan;Li Fangcai;Ma Jun;Chen Oixin;Chen Weishan(Department of Orthopeadics,2nd Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310009,China;Cancer Institute,2nd Affiliated Hospital,School of Medicine,Zhefiang University,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院脊柱外科,杭州310009 [2]浙江大学医学院附属第二医院肿瘤研究所,杭州310009

出　　处：《中华骨科杂志》2018年第24期1493-1501,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81472065,81572177);浙江省医药卫生科学研究基(2013KYB127).

摘　　要：目的探讨C2穹顶下减压术及C2单开门椎管成形术治疗高位颈椎(C2及其以上节段)后纵韧带骨化症(ossi-fication of posterior longitudinal ligament, OPLL)的临床疗效。 方法自2013年1月至2017年6月,收治涉及C2及其以上节段并造成脊髓压迫症状的颈椎OPLL患者57例,按纳入及排除标准共39例纳入研究。男22例,女17例;年龄39-71岁,平均(55.74±7.91)岁。对于C2节段OPLL,21例患者采用C2穹顶下减压术(C2穹顶下减压组),18例患者采用C2单开门椎管成形术(C2单开门组),所有患者均同期采用C3-C7单开门椎管成形术。术前及术后随访时均采用颈椎功能障碍指数(neck disability index, NDI)、日本矫形外科协会(Japanese Orthopedic Association,JOA)评分及疼痛视觉模拟评分(visual analogue scale,VAS)评估临床疗效;采用颈椎侧位X线片测量C2节段脊髓有效空间(space available for the spinal cord, SAC)评价影像学指标改善情况。结果所有患者均获得随访,随访时间为15-63个月,平均(42.3±17.7)个月。两组患者一般情况、术前及术后随访的NDI、JOA评分及JOA评分改善率的差异均无统计学意义。两组患者术后NDI、JOA评分、VAS评分、SAC较术前均有明显改善。C2穹顶下减压组术后轴性疼痛VAS评分(1.52±1.2)分,明显低于C2单开门组(2.06±0.87)分(t= -2.23,P<0.05),而C2单开门组术后SAC平均为(14.11±1.023)mm,明显大于C2穹顶下减压组(11.86±1.014)mm(t=-6.89,P<0.05)。随访期间未发现内固定失败或再次发生压迫征象。结论对涉及C2及其以上节段的颈椎高位OPLL患者,后路C2穹顶下减压术和C2单开门椎管成形术均能获得良好的减压效果;C2单开门椎管成形术的脊髓有效空间优于C2穹顶下减压术,但术后疼痛程度较C2穹顶下减压组严重,两组术后的神经恢复状况无明显差异。对于椎管内骨化块在C2椎体下缘水平占位超过椎管矢状径50%以上伴发育性椎管狭窄的患者,C2单开门椎管成形术�Objective To explore the clinical effects of C2 dome-like expansive laminoplasty and C2 expansive open-door laminoplasty in upper cervical(involve or above C2 segment) ossification of the posterior longitudinal ligament.Methods All of 39 patients (22 males and 17 females) withcervical ossification of the posterior longitudinal ligament up to C2 which causedcompression symptoms were operated with posterior cervical surgery in ourhospital from January 2013 to June 2017.The average age was 55.74+7.91 years old, ranging from 39 to 71 years. Among these patients, 21 patients underwent C2 dome-like expansive laminoplasty and 18 underwent C2 expansive open-door laminoplasty, the patients in both groups underwent the C3-C7 expansive open-door laminoplasty. The preoperative and postoperative Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) score, the xisual analog scale(VAS) and the space available for the spinal cord (SAC) of C2 segment in X-ray were measured and statistically analyzed.Results All patients were followed up, the follow-up time was from 15 to 63 months (mean 42.3±17.7 months). There was no significant difference in the general condition, NDI, JOA score and JOA score improvement rate between preoperative and postoperative follow-up in 2 groups. There were significant differences in the NDI, JOA, VAS and SAC between preoperative and postoperative follow-up in 2 groups. The VAS score in C2 dome-like expan-sive laminoplasty group 1.52±1.2 was significantly lower than that in C2 expansive open-door laminoplasty group 2.06±0.87(t=-2.23, P<0.05), while the SAC in C2 expansive open-door laminoplasty group 14.11±1.023 was significantly higher than that in C2 dome-like expansive laminoplasty group 11.86±1.014(t=-6.89, P<0.05). No failure of internal fixation or recurrent compres-sion was found during follow-up.Conclusion For patients with ossification of posterior longitudinal ligament up to C2 or higher level, both C2 dome-like expansive laminoplasty and C2 expansive open-door laminoplasty ca

关 键 词：颈椎 后纵韧带骨化 枢椎 减压术 外科 

分 类 号：R687.3[医药卫生—骨科学]