C3椎板切除、保留C7棘突的改良椎管成形术治疗颈椎后纵韧带骨化症  

Treatment of cervical ossification of the posterior longitudinal ligament by modified laminoplasty with C3 laminectomy and C7 spinous process retention

作　　者：梁昌详[1] 梁国彦[1] 肖丹[1] 黄帅豪 柯雨洪[1] 昌耘冰[1] Liang Changxiang;Liang Guoyan;Xiao Dan;Huang Shuaihao;Ke Yuhong;Chang Yunbing(Department of Orthopaedics,GuangDong General Hospital,GuangZhou 510080,China)

机构地区：[1]广东省人民医院脊柱外科,广东省医学科学院骨科中心,广州510080

出　　处：《中华骨科杂志》2018年第24期1502-1510,共9页Chinese Journal of Orthopaedics

基　　金：广东省自然科学基金(2015A030310379).

摘　　要：目的 探讨C3椎板切除、保留C7棘突的改良椎管成形术治疗颈椎后纵韧带骨化症(ossification of the posterior longitudinal ligament,OPLL)的临床疗效,并分析该术式减少轴性疼痛的机制.方法 2014年2月至2016年3月共收治OPLL患者133例,按纳入及排除标准共纳入42例.采用病例对照研究的方法,改良手术组22例,男13例,女9例;年龄39~77岁,平均(56.2±9.75)岁;采用C3椎板切除、C4~C6椎板单开门、C7椎板上半部分切除保留C7棘突的改良椎管成形术治疗.同期采用标准单开门椎管扩大成形术(标准手术组)患者20例,即C3~C7椎板单开门减压术治疗,男12例,女8例;年龄41~75岁,平均(53.7±8.23)岁.临床疗效评价采用日本骨科协会(Japanese Orthopaedic Association Scores,JOA)评分、颈椎功能障碍指数(neck disability index,NDI)及切口疼痛视觉模拟评分(visual analogue scale,VAS),影像学疗效评价采用颈椎生理曲度及活动度,记录两组患者术后轴性症状发生率及其他术后并发症.结果 42例患者均得到随访,随访时间15~29个月,平均(22.9±4.5)个月.两组患者术前各项指标的差异均无统计学意义,术后及随访时两组患者的JOA评分及NDI均较术前明显好转;末次随访时两组患者JOA评分的差异无统计学意义,而改良手术组患者NDI平均为6.56%±4.78%,优于标准手术组9.25%±7.63%.改良手术组术后第1天切口疼痛VAS评分低于标准手术组,此后随访期间两组VAS评分的差异均无统计学意义.改良手术组术后颈椎曲度平均为12.32°±8.26°,标准手术组为11.56°±8.05°,两组的差异无统计学意义.改良手术组术后颈椎活动度平均为39.68°±5.52°,标准手术组为33.51°±7.39°,差异有统计学意义.8例(19%)患者术后轴性症状加重或新出现轴性症状,改良手术组3例(13.6%),标准手术组5例(30%),两组间差异无统计学意义.随访期间无脑脊液漏、脊髓损伤、切口感染、椎板塌陷、术后再关门、内固定�Objective To observe the clinical efficacy of modified laminoplasty with C3 laminectomy and C7 spinous process retention in the treatment of cervical ossification of the posterior longitudinal ligament(OPLL).Methods From Febru-ary 2014 to March 2016, 133 cases of OPLL were admitted, and 42 OPLLs were included according to the inclusion and exclusion criteria. A case-control study was conducted. Twenty-two cases were included in modified group and 20 cases in traditional group. There were 13 males and 9 females in the modified surgery group, and the average age was 56.2±9.75 years (39-77 years).Modi-fied surgery was conducted with C3 laminectomy, C4-C6 laminoplasty, resection at the upper part of the C7 lamina and retaining the C7 spinous process. Meanwhile, there were 12 males and 8 females in the traditional surgery group, with an average age of 53.7±8.23 years (41-75 years). Patients in the traditional surgery group were treated with standard C3-C7 laminoplasty. The mean follow-up was 22.9±4.5 (15-29) months. The JOA, NDI scores of the two groups were recorded preoperatively and postoperatively. The physiological curvature and activity of the cervical spine before and after operation were observed, and the incidence of axonal symptoms and postoperative complications in both groups were recorded. Results The follow-up period was 15-28 months, with an average of (23.2 ± 4.8) months. There was no significant difference between the base line of two groups before operation. At the last follow-up, the JOA and NDI scores of the two groups were significantly improved. There was no difference of JOA scores be-tween the two groups at the last follow-up, while the NDI sores at the modified group(6.56±4.78) was superior to the traditional group(9.25±7.63). The VAS score at the first day after surgery in modified group was lower than that of the traditional group. The average cervical curvature of the patients in the modified surgery group and the standard surgery group were 12.32°±8.26° and 11.56°±8.05°, respec

关 键 词：颈椎 后纵韧带骨化 减压术 外科 

分 类 号：R687.3[医药卫生—骨科学]