前路手术治疗颈椎后纵韧带骨化症45例  

45 Cases Report of Cervical Ossification of the PosteriorLongitudinal Ligament by Anterior Approach

作　　者：唐步顺 颜程 何丽蔚 张小克 TANG Bushun;YAN Cheng;HE Liwei;ZHANG Xiaoke(The First People Hospital of Yongkang,Yongkang 321300,Zhejiang China)

机构地区：[1]浙江永康市第一人民医院脊柱外科,浙江永康321300

出　　处：《中国中医骨伤科杂志》2021年第8期58-61,65,共5页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:探讨前路手术治疗颈椎后纵韧带骨化症(OPLL)的疗效和注意事项。方法:回顾性分析2015年1月至2019年6月采用前路手术治疗的45例颈椎OPLL患者的临床资料。其中男34例,女11例;平均年龄(59.40±4.52)岁;平均病程1.8 a(3个月~4.5 a);局灶型14例,节段型23例,混合型8例;窄基型42例,宽基型3例。手术方式:椎间隙减压融合术(ACDF)5例,椎体次全切除减压融合术(ACCF)28例,ACDF+ACCF 12例。骨化的后纵韧带切除41例,漂浮4例。结果:45例患者均获得了12~22个月的随访,平均(15.5±3.6)个月。术后JOA评分、C_(2)~C_(7) Cobb角度均较术前明显改善,差异有统计学意义(P<0.01)。JOA评分改善优24例,良17例,有效4例,优良率为91.11%。术后6~9个月植骨全部融合,2例发生钛网塌陷。结论:前路手术治疗OPLL可以获得脊髓的直接减压和满意的疗效,但前路切除骨化的后纵韧带技术要求非常高,建议由经验丰富的术者完成。Objective:To investigate the clinical results of anterior approach fusion surgery for cervical ossification of the posterior longitudinal ligament(OPLL).Methods:From January 2015 to June 2019,45 cases of cervical OPLL were surgically treated via anterior approach.There were 34 males and 11 females with average age of(59.4±4.5)years old(48 to79)and the average course of disease was(1.8±0.7)years(0.25 to 4.50).Types of OPLL in the 45 cases included 14 focal OPLL,23 segmental OPLL and 8 mixed OPLL.Of which 42 cases were narrow base type and 3 cases were wide base type.The surgical methods for them,ACDF in 5 cases,ACCF in 28 cases and ACDF+ACCF in 12 cases.Ossified posterior longitudinal ligament was removed in 41 cases and floated in 4 cases.Results:The patients were followed up for 12 to 22 months((15.5±3.6)months on average).The JOA score and C2 to C7 Cobb angle were significantly improved after operation(P<0.01).The improvement rate of JOA score was excellent in 24 cases,good in 17 cases,effective in 4 cases,the excellent and good rate was 91.11%.All bone grafts were fused 6 to 9 months after surgery,and 2 cases had titanium mesh collapse.Conclusion:Anterior operation for OPLL can obtain direct decompression of spinal cord and satisfactory results.However,the technical requirements for anterior resection of the ossified posterior longitudinal ligament are very rigorous and sophisticated,and should be performed by experienced surgeons.

关 键 词：颈椎 后纵韧带骨化 前路减压 疗效 

分 类 号：R681.5[医药卫生—骨科学]