后路单开门减压原位固定融合术治疗颈椎后纵韧带骨化症的临床疗效  

Clinical outcomes of single open-door posterior decompression with instrumented in situ fusion for cervical ossification ofposterior longitudinal ligament

作　　者：李亚伟[1] 王冰[1] 吕国华[1] 李磊[1] 戴瑜亮 涂志明[1] 李鹏志[1] Li Yawei;Wang bing;Lyu Guohua;Li Lei;Dai Yuliang;Tu Zhiming;Li Pengzhi(Department of Spinal Surgery,The Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院脊柱外科,长沙410011

出　　处：《中华骨科杂志》2018年第24期1522-1529,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81601868);湖南省自然科学基金(2018JJ3752).

摘　　要：目的评价后路单开门椎管减压原位固定融合术(single open-doorposterior decompression with instrumented in situ fusion, PDF)和后路椎管扩大成形术(laminoplasty, LMP)治疗K线阴性颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament, OPLL)的临床疗效。方法回顾性分析2008年2月至2015年2月采用颈椎后路椎管减压手术治疗38例K线阴性OPLL患者的病历资料,男30例,女8例;年龄48-76岁,平均(56.3±9.7)岁;骨化块椎管占位率38.6%-72.5%,平均58.1%±13.6%。按手术方式进行分组,PDF组26例,LMP组12例。记录两组患者并发症发生情况,统计术前、术后及末次随访时C2-C7 Cobb角和日本骨科学会(Japanese Orthopaedic Association Scores,JOA)评分变化,计算末次随访时JOA评分改善率,并进行组内及组间统计分析。结果所有患者均获得随访,随访时间2.5-7.0年,平均(3.6±2.1)年。末次随访时PDF组JOA评分由术前平均(7.7±1.6)分改善至(11.8±1.9)分,差异有统计学意义(t=3.573,P<0.05),JOA评分改善率为44.2%±6.7%;LMP组JOA评分由术前平均(7.9±1.5)分改善至(9.1±2.1)分,差异亦有统计学意义(t=1.327,P<0.05),JOA评分改善率为29.5%±5.0%。两组间术前JOA评分比较,差异无统计学意义(t=0.365,P > 0.05);末次随访时的差异有统计学意义(t=3.941,P<0.05);JOA评分改善率的差异亦有统计学意义(t=6.741,P<0.05)。末次随访时PDF组C2-C7 Cobb角由术前3.8°±1.6°恢复至4.1°±2.0°,差异无统计学意义(t=0.587,P >0.05);LMP组由术前3.9°±1.2°减少至-2.1°±1.8°,差异有统计学意义(t=6.824,P<0.05)。两组术后共发生C5神经根麻痹10例(PDF组7例,LMP组3例),切口感染3例(PDF组2例,LMP组1例),PDF组和LMP组并发症发生率分别为34.6%和33.3%,差异无统计学意义(t=0.003,P >0.05)。结论 相较与LMP,PDF治疗K线阴性OPLL可以获得较为满意的脊髓神经功能改善率,并能够维持颈椎矢状位曲度,提高K线阴性OPLL患者术后的临床疗效。ObjectiveTo evaluate the clinical outcomes of K-line(-) ossification of posterior longitudinal ligament (OPLL) between single open-door posterior decompression with instrumented in situ fusion(PDF) and laminoplasty (LMP).MethodsFrom February 2008 to February 2015, 38 cases including 30 males and 8 females underwent posterior decompression due to K-line(-) OPLL in our institution. The age ranged from 48 to 76 years, mean 56.3±9.7 years. The OPLL canal occupation ratio ranged from 38.6% to 72.5%, mean 58.1%±13.6%. According to surgical procedures, 26 cases were in PDF group and 12 cases were in LMP group. The data collected from both groups included complications, C2-C7 Cobb angle and neurologic symptoms eval-uated based on the Japanese Orthopedic Association (JOA) score and JOA score recovery rate, and were analyzed with statistics in and between groups.Results All the patients were completed follow up with a mean of 3.6±2.1 years (range, 2.5 to 7.0 months). At the final follow-up, the postoperative JOA score was 11.8±1.9 points on average, improved from preoperative 7.7±1.6 points (t=3.757, P<0.05), the mean JOA score recovery rate was 44.2±6.7%in PDF group;and the postoperative JOA score was 9.1±2.1 points, improved from preoperative 7.9±1.5 points (t=1.327, P<0.05), the mean JOA score recovery rate was 29.5±5.0% in LMP group. No significant difference was found in preoperative JOA score between the two groups (t=0.365, P >0.05), however, there were significant differences in the postoperative JOA score (t=3.941, P<0.05) and JOA score recovery rate (t=6.741, P<0.05) at the final follow-up. In PDF group, the C2-C7 Cobb angle was 4.1±2.0°, similar with preoperative 3.8±1.6° (t=0.587, P >0.05). On the contrary, the C2-C7 Cobb angle was-2.1°±1.8°, lower than preoperative 3.9°±1.2° (t=6.824, P<0.05) in LMP group. Ten cases oc-curred C5 palsy (PDF:7;LMP:3), and 3 cases occurred wound infection (PDF:2;LMP:1). The complication rate was 34.6% and 33.3% (χ^2=0.003, P >0.05), respectively.Conclusion Com

关 键 词：颈椎 后纵韧带骨化 减压术 外科 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]