颈椎后纵韧带骨化自然进程及外科干预的影响  

Nature history and surgical intervention influence of cervical ossification of posterior longitudinal ligament

作　　者：石维 陈雄生 Shi Wei;Chen Xiongsheng(Department of Spine Surgery,Changzheng Hospital,Naval Military Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学附属长征医院脊柱外科,上海200003

出　　处：《中华骨科杂志》2018年第24期1537-1544,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81171753);上海市科委实验动物项目(15140903800).

摘　　要：颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament, OPLL)好发于50岁以上人群,可引起脊髓压迫症状,甚可致患者瘫痪。其发病率在亚洲,尤其是日本人群中较高,在其他地区和人种中发病率相对较低。目前治疗颈椎OPLL的手术方式较多,手术治疗短期疗效明确,但颈椎OPLL的自然进程及手术后长期预后缺乏综合性研究,临床医生对其自然状态下的疾病进展及长期预后缺乏直观认知。因此,探究颈椎后纵韧带骨化患者的自然进程及手术长期预后的一般规律至关重要。通过检索颈椎OPLL保守治疗或手术治疗后病灶演变的相关文献,总结其在自然进程下和外科干预后颈椎OPLL的影像学变化和临床症状进展,分析颈椎OPLL患者的长期预后,以期为临床医生提供参考。综合文献相关数据发现自然状态下骨化灶轴向长度每年增长约2 mm,厚度每年增长约0.2 mm,低龄、连续和(或)混合型骨化灶为骨化灶进展的主要危险因素。与自然进程相比,后路椎板切除融合术、各型前路手术可以减缓颈椎OPLL骨化灶进展,而无内固定的椎板切除术、椎板成形术则会加快骨化灶进展;此外,低龄、连续和(或)混合型骨化灶同样为术后骨化灶进展的危险因素。脊髓损害症状并非仅由骨化灶严重程度决定,骨化物椎管占有率、颈椎活动度、年龄、外伤史等因素均有影响。目前各类型手术后短期内均可以减轻颈椎OPLL脊髓损害症状,但总体而言,虽然前路手术并发症较多,但长期预后优于后路手术。Cervical ossification of posterior longitudinal ligament (OPLL) is common in peopleover 50 years old. It can lead to compression myelopathy, which may end in paralysis when it's severe enough. It has quite a high prevalence in Asian, espe-cially in Japan-cohort, while lower in other districts or races relatively. There have been many surgical methods aiming at cervical OPLL and all of them show satisfied short-term efficacy. However, there hasn't been a comprehensive discussion about disease evo-lution in natural circumstances as well as its long-term prognosis up till now, which means that clinicians haven’t got direct under-standing. In that case it does make sense to ensure patients' natural progression and long-term post-surgical prognosis, from which summarized their rules in different cases with cervical OPLL. It is possible to analyze the long-term prognosis and provide sugges-tions to clinicians, with collection of papers about cervical OPLL's progression after conservative or surgical treatment and sum-ming up cervical OPLL's radiological and clinical course either in natural circumstance or after surgical intervention.According to the review, ossified sites' axial length grows about 2 mm per year, while its thickness grows 0.2 mm per year. Young age and ossi-fied sites of continuous/mixed types are its risk factors. Compared with natural course, laminectomy with fusion and all kinds of an-terior approaches can inhibit ossification site's progression, while laminectomy and laminoplasty will speed it up. Young age and continuous/mixed type still contribute to the post-surgical progress of ossification sites. Symptoms of spinal cord are partly deter-mined by the worsen of ossified site, which in the meantime is related to rate of occupation, range of motion, age and trauma histo-ry. Current surgical approaches are all able to eliminate symptoms, though anterior approaches undertake more intraoperative com-plications as well as better long-term prognosis than posterior ones.

关 键 词：颈椎后纵韧带骨化症 外科干预 OPLL 长期预后 椎板切除术 压迫症状 手术治疗 脊髓损害 

分 类 号：R687.3[医药卫生—骨科学]