两种术式治疗长节段颈椎后纵韧带骨化症的疗效分析  

Effect analysis of two surgical methods in treatment of ossification of long segment cervical posterior longitudinal ligament

作　　者：范钦玮 朱忠培[1] 邵佳 高延征[2] 廖文胜[1] FAN Qin-wei;ZHU Zhong-pei;SHAO Jia;GAO Yan-zheng;LIAO Wen-sheng(Department o£Orthopedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Spine and Spinal Cord,Henan Provincial People1 s Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学第一附属医院骨外科,郑州450052 [2]河南省人民医院脊柱脊髓外科,郑州450003

出　　处：《医药论坛杂志》2022年第8期5-10,共6页Journal of Medical Forum

摘　　要：目的比较颈后路单开门椎管扩大成形术与全椎板切除椎管减压侧块螺钉固定术治疗颈椎后纵韧带骨化所致颈椎椎管狭窄的临床疗效。方法回顾性分析2017年12月至2020年12月郑州大学第一附属医院及河南省人民医院接受颈后路手术治疗颈椎后纵韧带骨化患者的临床资料,并对纳入的62例患者进行随访,其中34例患者行颈后路单开门椎管扩大成形术,28例行颈后路全椎板切除椎管减压侧块螺钉固定术,分别记为单开门组和全椎板组。62例患者均随访12个月,采用疼痛视觉模拟评分(VAS)评估患者术前与术后12个月的疼痛程度,采用日本骨科学会评分(JOA)评估患者术前与术后12个月的神经功能;测量术前与术后12个月颈椎曲度CCI、颈椎活动度CROM与颈椎矢状面垂直轴偏距C2-7SVA,并记录2组术后并发症情况。结果单开门组术前及术后12个月VAS评分分别为(6.89±1.27),(1.56±0.88),JOA评分分别为(7.78±1.92),(15.78±0.97),全椎板组术前及术后12个月VAS评分分别为(7.22±1.40),(1.12±0.98),JOA评分分别为(9.11±1.17),(15.44±1.01),2组患者术前与术后12个月VAS与JOA评分均有统计学差异(P<0.05)。2组患者术后CCI与CROM均有不同程度丢失,单开门组CCI丢失较多但CROM丢失较少,全椎板组与之相反,2组患者术后CCI及CROM丢失量均有统计学差异(P<0.05);术后12个月,单开门组C2-7SVA增加量大于全椎板组,差异有统计学意义(P<0.05);单开门组术后轴性症状7例(20.6%),C5神经根麻痹2例(5.9%),脑脊液漏1例(2.9%),切口感染2例(5.9%),总发生率35.3%(12/34);全椎板组术后轴性症状1例(3.6%),C5神经根麻痹4例(14.3%),脑脊液漏3例(10.7%),切口感染1例(3.6%),总发生率32.1%(9/28),2组术后并发症总发生率基本相同,差异无统计学意义(P>0.05)。结论在12个月的随访期内,两种术式在颈椎曲度、活动度及平衡维持方面存在差异,但临床疗效相似。Objective To compare the clinical efficacy of posterior single door laminoplasty and total laminectomy,spinal canal decompression and lateral mass screw fixation in the treatment of cervical spinal canal stenosis caused by ossification of cervical posterior longitudinal ligament.Methods The clinical data of patients with ossification of cervical posterior longitudinal ligament treated by posterior cervical surgery in the First Affiliated Hospital of Zhengzhou University and Henan Provincial People’s Hospital from December 2017 to December 2020 were retrospectively analyzed,and 62 patients were followed up.Among them,34 patients underwent posterior single door laminoplasty,28 patients underwent posterior total laminectomy,spinal canal decompression and lateral mass screw fixation,They were recorded as single door group and whole lamina group.62 patients were followed up for 12 months.The pain degree before and 12 months after operation was evaluated by pain visual analogue scale(VAS),and the neurological function before and 12 months after operation was evaluated by Japanese Orthopaedic Association score(JOA);The cervical curvature CCI,CROM and C2-7 SVA were measured before and 12 months after operation,and the postoperative complications of the two groups were recorded.Results The VAS scores before and 12 months after operation in the single door group were(6.89±1.27)and(1.56±0.88)respectively,and the JOA scores were(7.78±1.92)and(15.78±0.97)respectively.The VAS scores before and 12 months after operation in the whole lamina group were(7.22±1.40)and(1.12±0.98)respectively,and the JOA scores were(9.11±1.17)and(15.44±1.01)respectively.There was significant difference between the two groups(P<0.05).CCI and CROM were lost in different degrees in the two groups.In the single door group,CCI was lost more,but CROM was lost less.In the whole lamina group,on the contrary,there was significant difference in the loss of CCI and CROM between the two groups(P<0.05);12 months after operation,the increase of C2-7 SVA

关 键 词：颈椎 后纵韧带骨化症 椎管扩大成形术 全椎板切除术 

分 类 号：R61[医药卫生—外科学]