前路或后路手术治疗颈椎后纵韧带骨化症的中期疗效观察  

Anterior or posterior approaches for cervical ossification of posterior longitudinal ligament: a midterm follow-up

作　　者：汪文龙[1] 海涌[1] 关立[1] 刘玉增[1] 陈小龙[1] 朱文艺[1] 陈龙[1] 

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京市100020

出　　处：《中国脊柱脊髓杂志》2016年第7期577-584,共8页Chinese Journal of Spine and Spinal Cord

摘　　要：目的：观察颈椎前路椎体次全切减压融合术（ACCF）和颈椎后路单开门椎管扩大成形术在治疗颈椎后纵韧带骨化症（OPLL）的中期临床疗效和影像学改善情况。方法：2010年1月。2012年12月我院收治33例颈椎OPLL患者，男17例，女16例；年龄41～78岁（58．6±8．8岁）。其中16例骨化块累及2个节段及以内者通过ACCF切除骨化块减压（A组）；17例骨化块累及2个节段以上、前路切除有困难者采用后路单开门椎管扩大成形术（B组）。所有患者术前、术后3个月、1年、2年、3年和末次随访时进行JOA评分。通过配对样本t检验分析两组患者术前、术后和末次时的JOA评分、颈椎曲度及椎管狭窄率的变化情况。结果：A组1例术后发生吞咽困难；B组1例发生脑脊液漏，1例发生切口感染。均经对症处理后痊愈。A组随访48．56±8．02个月，B组随访52．59±8．88个月。两组患者术后JOA评分均较术前有显著性改善（P〈0．05）；术后和末次随访时颈椎曲度较术前无明显差异（P〉0．05）；A组末次随访骨化块面积明显大于术后（P〈0．05），B组末次随访骨化块面积较术后无明显差异（P〉0．05）。结论：对于颈椎OPLL，ACCF和后路单开门椎管成形术均为有效且安全的术式．中期随访疗效满意。前者通过切除或“漂浮”骨化块达到有效减压；后者能够扩大椎管缓解脊髓压迫，中期随访椎管狭窄率维持稳定。Objectives： To observe the mid-term clinical outcomes and radiological parameters of anterior cervical corpectomy and fusion（ACCF） and posterior single-door laminoplasty in cervical ossification of posteri- or longitudinal ligament（OPLL）. Methods： All 33 cervical OPLL cases（17 males, 16 females; mean age, 58.6± 8.8 years; range, 41 to 78 years） treated in our department between January 2010 and December 2012 were analyzed retrospectively. 16 cases with less than 2 segments involved were treated by ACCF （group A）. 17 cases with more than 2 segments involved were treated by the posterior single-door laminoplasty（group B）. All patients included in the study had preoperative, postoperative cervical X-rays, CTs and MRIs. Japanese Or- thopaedic Association （JOA） score was used to evaluate the clinical outcomes of the two groups. Curvature angle and canal stenosis rate before surgery and at the follow-up were analyzed. The clinical and radiograph- ic differences between the two groups were compared by using the paired t-test. Results： The mean follow- up time in group A and B was 48.56±8.02 and 52.59±8.88 months, respectively. One case presented postop- erative dysphagia in group A and recovered by self in the follow-up. One case occured cerebrospinal fluid leakage and one case occured postoperative wound infection in group B, they recovered by delayed drainage and placing drainage-tube respectively. The postoperative JOA score was significantly higher than the preoper- ative（P〈0.05）. Cervical curvature showed no significant difference（P〉0.05） before Surgery, at post operation im- mediately and the last follow-up. At the last follow-up, ossified mass area was significantly higher than thepostoperative in group A（P〈0.05）, but not in group B（P〉0.05）. Conclusions： For cervical OPLL, the ACCF and posterior single-door laminoplasty appear to be efficient and safer approaches. Posterior single-door laminoplasty is able to enlarge the canal and relieve compression, and

关 键 词：颈椎后纵韧带骨化症 手术 椎管狭窄率 中期随访 

分 类 号：R681.5[医药卫生—骨科学]