不同手术入路治疗颈椎后纵韧带骨化症效果对比  

Comparison of different surgical approaches in the treatment of ossification of posterior longitudinal lig-ament

作　　者：陈崎[1] 秦练 李名武[1] 陈又年[1] 周赤兵[1] CHEN Qi;QIN Lian;LI Ming-wu;CHEN You-nian;ZHOU Chi-bing(Department of Orthopedics, Huangshi Central Hospital, Hubei, Huangshi 435000, China)

机构地区：[1]黄石市中心医院骨外科,湖北黄石435000

出　　处：《中国医学前沿杂志（电子版）》2017年第6期38-42,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：湖北省卫生厅科研基金资助项目(2013Z-Y26)

摘　　要：目的观察颈椎前路椎体次全切减压融合术(以下简称前路手术)和颈椎后路单开门椎管扩大成形术(以下简称后路手术)治疗颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)的疗效。方法选取2013年1月至2016年1月于本院接受治疗的OPLL患者88例为研究对象,根据骨化块节段数和椎管狭窄率将患者分为A组(36例)与B组(52例)。A组患者采用前路手术治疗,B组患者采用后路手术治疗。比较两组患者术前、术后3个月和9个月日本骨科协会(Japanese Orthopaedic Association,JOA)评分、手术情况、手术前后影像学检查结果及术后并发症发生情况。结果 A组患者手术时间明显长于B组(P<0.05),术后住院天数显著短于B组(P<0.05),术中出血量显著少于B组(P<0.05)。术后3个月和9个月B组患者JOA评分均显著高于A组(P<0.05)。手术前后A组患者颈椎曲度均明显大于B组(P<0.05),骨化块面积均明显小于B组(P<0.05),椎管狭窄率均明显低于B组(P<0.05)。A组患者术后并发症总发生率显著高于B组(P<0.05)。结论前路手术和后路手术对于OPLL均具有较好的治疗效果,对于骨化块<3个节段、有明显椎间盘突出或伴有显著神经根受压症状的患者以前路手术治疗为主;对于骨化块节段数较多、椎管狭窄率较高的患者,后路手术能够有效恢复其神经功能且术后并发症较少、操作灵活简单。Objective To observe the efficacy of anterior cervical corpectomy decompression and fusion(anterior approach surgery)and posterior cervical open-door laminoplasty(posterior approach surgery)in the treatment of ossification of posterior longitudinal ligament(OPLL).Method88patients with OPLL treated in our hospital from January2013to January2016were selected as the subjects,and they were divided into group A(36cases)and group B(52cases)according to the number of ossification segments and the stenosis rate of the vertebral canal.Patients in group A were treated with anterior approach surgery,patients in group B were treated with posterior approach surgery.The Japanese Orthopaedic Association(JOA)scores at preoperative,postoperative3months and9months,operation condition,imaging inspection results before and after operation and postoperative complications of the two groups were compared.Result The operation time of group A was significantly longer than that of group B(P<0.05),the postoperative hospital stay was significantly shorter than that of group B(P<0.05),the amount of bleeding during operation was significantly less than that of group B(P<0.05).The scores of JOA in group B were significantly higher than those of group A at3months and9months after operation(P<0.05).The curvature of cervical spine before and after operation in group A was significantly higher than that in group B(P<0.05),ossification area before and after operation in group A was significantly less than that in group B(P<0.05),spinal stenosis rate before and after operation in group A was significantly lower than that in group B(P<0.05).The overall complication rate of group A was significantly higher than that of group B(P<0.05).Conclusion The two treatment methods have better effects on OPLL,patients with ossification less than3segments or pronounced disc herniation or with prominent nerve root compression symptoms are treated primarily with anterior approach surgery,for patients with higher ossification rate and higher stenosis rate,posterior

关 键 词：颈椎前路椎体次全切减压融合术 颈椎后路单开门椎管扩大成形术 颈椎后纵韧带骨化症 椎管狭窄率 

分 类 号：R687.3[医药卫生—骨科学]