颈椎后纵韧带骨化前路骨化物复合体前移技术及临床疗效分析  

Clinical study of anterior controllable antedisplacement and fusion for the treatment of cervical ossification of posterior longitudinal ligament

作　　者：史建刚[1] 孙璟川[1] 郭永飞[1] 杨海松[1] 徐锡明[1] 王元[1] 王英杰[1] 孔庆捷[1] 周盛源[1] 史国栋[1] 许国华[1] 陈德玉[1] 陈雄生[1] 袁文[1] 贾连顺[1] Shi Jiangang;Sun Jingchuan;Guo Yongfei;Yang Haisong;Xu Ximing;Wang Yuan;Wang Yingjie;Kong Qingjie;Zhou Shengyuan;Shi Guodong;Xu Guohua;Chen Deyu;Chen Xiongsheng;Yuan Wen;Jia Lianshun(The Second Department of Spine Surgery,Changzheng Hospital,the Second Military Medical University,Shanghai 200433,Chin)

机构地区：[1]海军军医大学(第二军医大学)附属长征医院骨科医院第二脊柱外科,上海200433

出　　处：《中华骨科杂志》2018年第15期919-926,共8页Chinese Journal of Orthopaedics

摘　　要：目的 探讨颈椎前路椎体骨化物复合体前移融合术治疗颈椎后纵韧带骨化症的临床疗效.方法 回顾性分析2017年3月至2017年10月采用颈椎前路椎体骨化物复合体前移融合术治疗并获得随访的45例颈椎后纵韧带骨化症患者资料,男25例,女20例;年龄45～68岁,平均57.5岁;C3椎体18例,C4椎体30例,C5椎体40例,C6椎体34例,C7椎体7例.术前及末次随访采用日本矫形外科协会（Japanese Orthopaedic Association,JOA）评分系统评估神经系统功能;在颈椎侧位X线片上测量颈椎曲度,在CT扫描横截面上测量椎管最大狭窄率,颈椎MRI评价脊髓受压情况.结果 45例患者术后共前移椎体129个,其中涉及前移4个椎体11例（占34.1％）,前移3个椎体21例（48.8％）,前移2个椎体9例（14.0％）,前移1个椎体4例（3.1％）.45例患者均获得随访,随访时间3～6个月,平均3.9个月.神经功能均得到不同程度恢复,JOA评分由术前（9.5±2.3）分改善至末次随访时的（15.4±3.6）分;JOA评分改善率为71.3％±9.6％.术前颈椎平均曲度为4.5°±3.8°,术后颈椎曲度显著增加,术后颈椎平均曲度为10.3°±4.8°.椎管狭窄率由术前的54.3％±8.2％降低为12.5％±5.3％.MRI示颈脊髓均得到充分的原位减压.术中无一例发生脊髓损伤、术后均未出现血肿、切口感染、食道瘘、深部感染、血管损伤等严重并发症.结论 颈椎前路椎体骨化物复合体前移融合术可安全有效治疗颈椎后纵韧带骨化症,降低椎管狭窄率,增加颈椎曲度,明显改善神经症状,疗效满意,是一种可供选择的治疗颈椎后纵韧带骨化症的手术方式.Objective To investigate the clinical effect of anterior controllable antedisplacement and fusion （ACAF） for the treatment of ossification of the posterior longitudinal ligament （OPLL） of the cervical spine.Methods The data of 45 cases with cervical posterior longitudinal ligament ossification treated by ACAF from March 2017 to October 2017 were retrospectively analyzed,including 25 males and 20 females,age 45-68 years,average 57.5 years.There were 18 cases involving C3 vertebral body,30 cases involving C4 vertebral body,40 cases involving C5 vertebral body,34 cases involving C6 vertebral body,and 7 cases involving C7 vertebral body.The function of the neural function was evaluated by the Japanese Orthopaedic Association （JOA） scoring system at preoperation and latest follow-up.The curvature of the cervical spine was measured on the lateral X-ray film of the cervical spine,the maximum occupying ratio of the spinal canal was measured on the cross section of the CT scan,and compression of the cervical spinal cord was evaluated by the cervical MRI.Results Patients were followed up for 3 to 6 months （average,3.9 months）.The improvement of neurological function was obtained in all the patients.The JOA score improvement rate at the latest follow-up was 71.3%±9.6%.The cervical lordosis was improved from preoperative 4.5°±3.8° to 10.3°±4.8° at the latest follow-up.The canal stenosis ratio was decreased from preoperative 54.3%±8.2% to 12.5%±5.3% at the latest follow-up.MRI showed that the cervical spinal cord was adequately decompressed in situ.No specific complications were identified that were associated with this technique.Conclusion The present study elaborates the surgical tips and demonstrates the satisfactory outcome of ACAF for the treatment of OPLL.This novel technique has the potential to serve as an alternative surgical technique for the treatment of cervical OPLL.

关 键 词：颈椎 后纵韧带骨化 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]