前路骨化物复合体前移融合与后路椎板成形术治疗颈椎OPLL比较  

Anterior ossification complex antedisplacement fusion versus posterior laminectomy for cervical ossification of posterior longitudinal ligament

作　　者：王贵江[1] 杨成[1] 崔涛 孙立山[1] 王丽国[1] 杨建 王玲[1] WANG Gui-jiang;YANG Cheng;CUI Tao;SUN Li-shan;WANG Li-guo;YANG Jian;WANG Ling(The Fourth Department of Orthopaedics,Central Hospital of Cangzhou City,Cangzhou 061001,China)

机构地区：[1]河北省沧州市中心医院骨四科

出　　处：《中国矫形外科杂志》2019年第11期976-980,共5页Orthopedic Journal of China

基　　金：沧州市重点研发计划指导项目(编号:172302166)

摘　　要：[目的]比较前路骨化物复合体前移融合术(AOCAF)与后路椎板成形术(PL)治疗颈椎后纵韧带骨化症(OPLL)的临床效果。[方法] 2017年8月~2018年4月于本院手术治疗的OPLL患者94例,按手术方式分为AOCAF组45例,PL组49例。比较两组JOA及VAS评分,影像测量椎管矢状径、颈椎生理曲度、椎管狭窄率,采用多元逻辑回归分析影响神经功能的因素。[结果]两组患者手术顺利,均未发生血管、神经损伤等严重并发症。两组患者术后随访7~12个月,两组患者末次随访时的JOA评分均较术前显著增加(P<0.05),而VAS评分显著降低(P<0.05);末次随访时AOCAF组的JOA评分和VAS评分显著优于PL组(P<0.05);尽管术前两组间上述评价的差异均无统计学意义(P>0.05)。影像测量方面,术前两组患者椎管矢状径、椎管狭窄率比较差异均无统计学意义(P>0.05);末次随访时,两组椎管矢状径较术前显著增加(P<0.05),而椎管狭窄率则较术前显著降低(P<0.05);末次随访时,AOCAF组椎管矢状径、颈椎生理曲度和椎管狭窄率显著优于PL组(P<0.05)。逻辑回归表明:术前患处椎体矢状径是影响术后神经功能恢复的主要因素(P<0.05)。[结论] AOCAF对颈椎OPLL疗效优于PL,而影响术后神经功能恢复的主要因素是术前患处椎体矢状径。[Objective] To compare the clinical outcomes of anterior ossification complex antedisplacement fusion(AOCAF) versus posterior laminectomy(PL) for cervical ossification of posterior longitudinal ligament(OPLL)[Methods] From August 2017 to April 2018, a total of 94 patients underwent surgical treatment for cervical OPLL in our department. Based on the surgical procedure performed, the patients were divided into two groups, including 45 patients in the AOCAF group and 49 patients in the PL group. The Japanese Orthopaedic Association(JOA) score and visual analogue scale(VAS) for pain, as well as the sagittal diameter of involved vertebral canal, cervical sagittal curvature and ratio of canal occupied measured on images were compared between the two groups. In addition, a multiple logistic regression was conducted to explore the factor related to neurological function recovery.[Results] All patients in both groups had the surgical procedures performed smoothly without serious complications, such as neurovascular injuries. The patients were followed up for 7~12 months. At the latest follow-up the JOA score significantly increased, whereas the VAS score significantly decreased in both groups compared with those preoperatively(P<0.05). The AOCAF group proved significantly superior to the PL group regarding to the JOA and VAS scores at the latest follow up(P<0.05), although no statistically significant differences were notice in the two scores between them before operation(P>0.05). In term of radiographic measurements, nevertheless no statistically significant differences between the two groups in any imaging parameter were notice before operation(P>0.05), the sagittal diameter significantly increased, while the ratio canal occupied significantly decreased at the latest follow up in both groups(P<0.05). By contrast, the AOCAF groups proved significantly superior to the PL group in sagittal diameter of involved vertebral canal, cervical sagittal curvature and ratio of canal occupied at the latest follow up(P<0.05).The mult

关 键 词：后纵韧带骨化症(OPLL) 前路骨化物复合体前移融合术(AOCAF) 后路椎板成形术(PL) 

分 类 号：R686.5[医药卫生—骨科学]