轻度颈椎后纵韧带骨化症保守治疗:预后因素及手术修复时机选择  

Conservative treatment of mild ossification of cervical posterior longitudinal ligament: prognostic factors and timing of surgical repair

作　　者：申沧海[1] 冯永健[1] 王力国[1] 杨成[1] 彭宁宁[1] 王贵江[1] 郭旭[1] 

机构地区：[1]沧州市中心医院骨四科,河北省沧州市061001

出　　处：《中国组织工程研究》2015年第4期531-536,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:对于中重度脊髓受压的颈椎后纵韧带骨化症患者,手术效果明显优于保守治疗的效果。然而,轻度、进展缓慢的颈椎后纵韧带骨化症患者可以在较长时间内并无严重脊髓受压的症状和体征,手术治疗对于保守治疗的优越性并未得到证实。目的:分析轻度颈椎后纵韧带骨化症保守治疗的预后因素,并为保守治疗预后不良患者选择手术时机提供证据。方法:前瞻性分析2007年1月至2011年1月住院治疗的71例轻度颈椎后纵韧带骨化症患者的临床资料,日本骨科协会(JOA)评分≥13分。所有患者入院时均接受保守治疗,并记录可能影响保守治疗的预后因素,出院后每3个月进行定期随访。入院和出院随访期间采用JOA评分评价脊髓神经功能。对于随访期间脊髓受压症状加重的患者(JOA评分<13分并且较初次住院时JOA评分降低≥2分)给予手术治疗。结果与结论:截至2014年2月,67例患者完成3年随访,随访期间19例患者脊髓受压症状加重后接受手术治疗(手术组),而剩余48例患者随访期间始终接受保守治疗(保守组)。统计学分析显示,颈椎管矢状径较窄和节段不稳是保守治疗预后不良的因素。随访开始时手术组与保守组JOA评分差异并无显著性意义(P>0.05)。尽管手术组患者术前JOA评分较随访开始时降低,差异有显著性意义(P<0.05),但给予手术治疗后,末次随访时手术组与保守组JOA评分差异并无显著性意义(P>0.05)。提示保守治疗是轻度颈椎后纵韧带骨化症患者首选有效的修复方案。颈椎管矢状径较窄、颈椎不稳是保守治疗预后不良的因素,对于存在预后不良因素的患者,若保守治疗期间脊髓受压症状加重,给予手术治疗可使患者预后得到改善。BACKGROUND：The therapeutic effect of surgery is apparently better than conservative treatment for ossification of the posterior longitudinal ligament of moderate to severe spinal cord compression. However, patients with mild and slow developed ossification of the posterior longitudinal ligament do not have severe signs and symptoms of spinal cord compression in a long period. The superiority of surgery treatment has not been confirmed compared with the conservative treatment. OBJECTIVE： To analyze the prognostic factors for patients with mild ossification of cervical posterior longitudinal ligament and to provide evidence for selecting timing of surgery patients with unfavourable prognosis after conservative treatment. METHODS： Clinical information of 71 patients with mild ossification of cervical posterior longitudinal ligament,＆nbsp;who were treated from January 2007 to January 2011, was prospectively analyzed. The Japanese Orthopedic Association score was at least 13 points. Al patients received conservative management on admission. Prognostic factors that possibly affected conservative treatment were recorded. Folow-up was regularly conducted every 3 months after discharge. Neurological function of spinal cord was evaluated using Japanese Orthopedic Association score during folow-up of admission and discharge. Patients with increased symptom of spinal compression （Japanese Orthopedic Association score RESULTS AND CONCLUSION：At the end of February 2014, 67 patients completed more than 3-year folow-up. Only 19 patients with increased symptom of spinal compression received surgery treatment （surgery group）. The remaining 48 patients received conservative treatment during folow up （conservative group）. Statistical analysis indicated that patients with stenosis of cervical spinal canal and segmental instability have a poor prognosis of conservative treatment. There was no significant difference in Japanese Orthopedic Association score between surgery group and conservative group at first f

关 键 词：植入物 脊柱植入物 颈椎 骨化 后纵韧带 保守治疗 预后 

分 类 号：R318[医药卫生—生物医学工程]