结合K线分析颈椎后纵韧带骨化患者的颈椎活动度与手术预后的关系  

Combining K-line to analyse the relationship between cervical range of motion of patients with ossification of cervical posterior longitudinal ligament and surgical prognosis

作　　者：王亚楠[1] 谢梦琦 轩安武 郭明明[1] 李青松[1] 马飞 王琪[1] WANG Ya-nan;XIEMeng-qi;XUANAn-wu;GUO Ming-ming;LI Qing-song;MA Fei;WANG Qi(Department of Orthopaedics,the General Hospital of Shenyang Military,Shenyang 110000,Liaoning,China)

机构地区：[1]沈阳军区总医院骨科,辽宁沈阳110000

出　　处：《中国骨伤》2018年第8期763-768,共6页China Journal of Orthopaedics and Traumatology

基　　金：中国博士后科学基金面上项目(编号:2015M582821)~~

摘　　要：目的:结合K线(颈椎侧位X线片上C_2及C_7椎管中点的连线)分析颈椎后纵韧带骨化患者的颈椎活动度与手术预后的关系。方法:对2014年4月至2017年3月行颈椎后路单开门椎管扩大成形术的42例颈椎后纵韧带骨化(cervical ossification of the posterior longitudinal ligament,OPLL)患者进行回顾性分析。根据后纵韧带骨化与K线的位置关系,患者被分为K线(+)组及K线(-)组。后纵韧带骨化病灶未超过K线称为K线(+),反之,后纵韧带骨化病灶越过K线称为K线(-)。观察术前及术后3个月JOA(Japanese Orthopedic Association)评分,并计算术后3个月JOA改善率评估患者神经功能恢复情况。通过影像学资料测量术前及术后3个月后纵韧带骨化的侵占率(occupation ratio,OOR),颈椎生理曲度(cervical lordotic angles,CLA)和颈椎前凸值(cervical lordotic value,CLV)。评估不同的K线分组中,CLV>0组和CLV≤0组之间患者的术后神经功能恢复之间的联系。结果:K线(+)组和K线(-)组患者的术前CLA分别为(14.7±9.6)°和(-6.4°±9.5)(P<0.05),术后3个月分别为(14.0±8.0)°和(-1.4±10.4)°(P<0.05);术前JOA评分分别为10.9±3.2和11.2±2.5(P>0.05),术后3个月分别为14.2±1.8和12.6±2.2(P<0.05),术后3个月JOA改善率分别为(54.7±17.6)%和(25.5±15.7)%(P<0.05)。K线(+)组中,术后3个月CLV>0组的患者29例,其术后3个月JOA改善率(52.3±17.2)%,术后3个月CLV≤0组的患者4例,其术后3个月JOA改善率为(72.2±7.8)%,术后3个月CLV≤0组患者JOA改善率明显优于术后3个月CLV>0组(P<0.05)。结论:无论患者颈椎后纵韧带骨化分类为K线(+)或K线(-),颈椎后路单开门椎管扩大成形手术都能够很好的改善患者的神经症状,尤其K线(+)组的患者,具有较好的预后效果。K线(+)组患者术后3个月CLV>0时,其JOA改善率较CLV≤0的患者差。Objective：Combining K line（the connecting line of the midpoint of C2 and C7 spinal canal on the cervical lateral X ray film） to analyze the relationship between cervical range of motion of patients with ossification of posterior longitudinal ligament（OPLL） and surgical prognosis. Methods：A total 42 patients with ossification of cervical posterior longitudinal ligament underwent cervical posterior single open door laminoplasty between April 2014 and March 2017 were retrospectively ananyzed. The patients were dividing into K line（＋） group and K line（-） group according to the position realationship of OPLL and K line. The lesion of ossification of the posterior longitudinal ligament was not over than the K line known as K line（＋）. Conversely,the lesion of ossification of the posterior longitudinal ligament crossing the K line was called K line（-）. Preoperative and postoperative 3 months JOA scores were observed,and postoperative 3 months JOA improvement rate were computed to assess patient＇s neurological function recovery. Preoperation and postoperative 3 months,OPLL occupation ratio（OOR）,cervical lordotic angles（CLA） and cervical lordotic value（CLV） were measured respectively. The realationship between postoperative neurologic functional recovery in patients of CLV0 group and CLV ≤0 group was evaluated in different K line subgroups. Results：For the patients in K（＋） group and K（-） group,preoperative CLA were（14.7±9.6）° and（-6.4 ±9.5）°（P〈0.05） respectively,postoperative at 3 months CLA were（14.0±8.0）° and（-1.4±10.4）°（P〈0.05） respectively; preoperative JOA scores were 10.9±3.2 and 11.2±2.5（P〈0.05） respectively,postoperative at 3 months JOA scores were 14.2±1.8 and 12.6 ±2.2（P 0.05） respectively,and postoperative at 3 months JOA score improvement rate were（54.7 ±17.6）% and（25.5±15.7）%（P〈0.05） respectively. In the K line（＋） group,there were 29 patients in CLV0 group at 3 months after operat

关 键 词：颈椎 后纵韧带骨化 K线 颈椎活动度 

分 类 号：R687.3[医药卫生—骨科学]