不同术式颈椎单开门椎管成形术治疗多节段OPLL的疗效分析  

Clinical Results of Different Cervical Open Door Laminoplasty for Multi-level Ossification of Posterior Longitudinal Ligament

作　　者：唐向盛[1] 姜良海 谭明生[1] 移平[1] 杨峰[1] 郝庆英[1] Tang Xiangsheng;Jiang Lianghai;Tan Mingsheng;YI Ping;YANG Feng;HAO Qingying(Department of Spine Surgery,China-Japan Friendship Hospital,Beijing 100029,China;Department of Orthopedic Surgery,Qingdao Municipal Hospital,Qingdao 266071,China)

机构地区：[1]中日友好医院脊柱外科,北京100029 [2]青岛市市立医院骨科,山东青岛266071

出　　处：《实用骨科杂志》2018年第4期289-293,317,共6页Journal of Practical Orthopaedics

基　　金：首都临床特色应用研究与成果推广(Z161100000516009)

摘　　要：目的分析不同术式颈椎单开门椎管成形术治疗后纵韧带骨化症的临床疗效。方法回顾性分析2013年6月至2016年6月,使用传统单开门椎管成形术(传统组)、单开门椎管成形联合微型钛板内固定术(钛板组)和改良单开门椎管成形联合侧块螺钉内固定术(改良组)治疗96例多节段颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)的临床资料。传统组患者37例,男22例,女15例,年龄34~68岁,平均54.3岁;钛板组患者27例,男15例,女12例,年龄36~65岁,平均56.2岁;改良组为多节段OPLL合并颈椎不稳患者,共32例,男19例,女13例,年龄36~69岁,平均55.7岁。记录三组患者的手术时间、出血量、并发症、术前及随访各时间点的颈椎日本骨科协会(Japanese orthopedic association,JOA)评分以及颈肩部疼痛视觉模拟评分(visual analogue scale,VAS)、术后1周及随访各时间点的颈椎椎板开门角度,将数据进行分析处理。结果三组患者均手术顺利,随访时间15~51个月。三组的手术时间、出血量差异无统计学意义(P>0.05)。术后三组的JOA评分、VAS评分均较术前改善,差异有统计学意义(P<0.01)。三组的术前及末次随访时JOA评分、神经功能改善率、VAS评分均差异无统计学意义(P>0.05)。三组术后1周的椎板开门角度差异无统计学意义(P>0.05),末次随访时传统组椎板开门角度低于钛板组、改良组(P<0.01)。传统组8例(21.6%)患者术后出现轴性症状,钛板组为3例(11.1%),改良组为4例(12.5%),传统组轴性症状发生率高于钛板组、改良组;传统组5例(13.5%)患者术后出现C5神经麻痹,钛板组3例(11.1%),改良组3例(9.4%)。结论三种颈椎单开门椎管成形术治疗多节段OPLL均能达到有效减压、提高神经功能的效果。使用单开门椎管成形联合微型钛板内固定术和改良单开门椎管成形联合侧块螺钉内固定术能较好地维持椎板开门角度,同时降低轴性症状发生�Objective To investigate the effect of different cervical open door laminoplasty for multi-level ossification of posterior longitudinal ligament.Methods From June 2013 to June 2016,96 cases with multi-level ossification of posterior longitudinal ligament(OPLL)underwent three different methods of cervical open door laminoplasty.37 cases underwent traditional open door laminoplasty(traditional group),27 cases underwent open door laminoplasty and titanium miniplate fixation(miniplate group),and 32 cases underwent modified open door laminoplasty and lateral mass screw fixation(modified group).22 males and 15 females with a mean age of 54.3(range,34~68)years old were included in the traditional group.15 males and 12 females with a mean age of 56.2(range,36~65)years old were included in the miniplate group.19 males and 13 females with a mean age of 55.7(range,36~69)years old were included in the modified group.Patients in the modified group had multi-level OPLL and cervical instability.Operation time,intraoperative blood loss,complications,pre-and post-operative Japanese Orthopedic Association(JOA)score,pre-and post-operative neck and arm Visual Analogue Scale(VAS)score,and postoperative lamina open angle were recorded and analyzed.Results All the patients with OPLL underwent surgeries successfully.The follow-up time was 15~51 months.No significant differences in operation time and blood loss were found among the three groups(P>0.05).All patients in three groups had improved JOA scores and decreased VAS scores after surgeries(P<0.01).There were no significant differences in pre-and post-operative JOA score,improvement rate of JOA score,or VAS scores among three groups(P>0.05).The three groups had similar lamina open angles at one week postoperatively(P>0.05).At last follow-up,the traditional group had a smaller lamina open angle than the miniplate group and modified group(P<0.01).8 cases in traditional group,3 cases in miniplate group,and 4 cases in modified group suffered axial symptom after surgery.The traditional gr

关 键 词：颈椎 后纵韧带骨化 椎管成形 微型钛板 螺钉 

分 类 号：R681.55[医药卫生—骨科学]