颈椎高位后纵韧带骨化单开门成形颈后肌重附着  

Unilateral open-door laminoplasty combined with reattachment of posterior muscle for upper cervical ossification of poste⁃rior longitudinal ligament

作　　者：周纪平 张蕾 李佳佳 刘永强 刘彬 杨永军 ZHOU Ji-ping;ZHANG Lei;LI Jia-jia;LIU Yong-qiang;LIU Bin;YANG Yong-jun(Wendeng Ortho-paedic Hospital of Shandong Province,Weihai264400,China;Shandong University of Traditional Chinese Medicine,Jinan250014,China)

机构地区：[1]山东省文登整骨医院,山东威海264400 [2]山东中医药大学,山东济南250014

出　　处：《中国矫形外科杂志》2022年第19期1798-1801,共4页Orthopedic Journal of China

摘　　要：[目的]介绍颈椎高位后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)单开门成形和肌肉止点重建的手术技术和初步临床效果。[方法]2015年3月—2019年3月对16例多节段累及C_(2)及以上椎体的OPLL患者行颈后路单开门椎管扩大成形术加颈后肌肉重建术。显露C_(1~7)双侧椎板及椎间关节,咬平C_(2~7)棘突,C_(4、6)棘突基底部打孔,于C_(3~7)双侧做一骨槽,左侧仅切除外板,右侧切除全板,将C_(3~7)椎板自右侧向左侧整体掀开约1.5 cm,用微型钛板固定C_(3、5、7)椎板于相应右侧块,C_(4、6)用丝线固定。切除C_(2)椎板,于C_(2)双侧椎弓根置入螺钉,横向置入预弯钢板,切除寰椎后弓,颈后肌肉缝合固定于C_(2)钢板上重建肌肉起点。[结果]所有患者均顺利完成手术,末次随访VAS和JOA评分均较术前显著改善(P<0.05)。末次随访颈椎活动度较术前无明显变化(P>0.05)。[结论]颈后路单开门椎管扩大成形术加颈后肌肉重建能够有效缓解临床症状,避免术后出现抬头无力现象,对多节段高位OPLL治疗效果良好。[Objective]To introduce the surgical techniques and preliminary clinical results of unilateral open-door laminoplasty com⁃bined with reattachment of posterior muscle for upper cervical ossification of posterior longitudinal ligament(OPLL).[Methods]From March 2015 to March 2019,16 patients with multiple levels of OPLL involving C_(2)or upper underwent unilateral open-door laminoplasty combined with reattachment of posterior muscle.After exposing C_(1~7)bilateral lamina and facets,the C_(1~7)spine processes were removed with holes punched on base of C4 and C6.Bilateral bone slots on C_(3~7)were made,with total bone removed on the right side,while outer bone corti⁃cal removed on the left side.Subsequently,the lamina in a whole was carefully raised on the right side about 1.5 cm,and fixed with mini tita⁃nium plate on C_(3),C_(5)and C_(7),while suture tie on the C_(4)and C6.The C_(2)total laminectomy was conducted,and bilateral pedicle screws were in⁃serted with a transvers plate fixed on the C_(2).Finally,the posterior cervical muscle was sutured on the C_(2)plate to reconstruct the attachment of the muscle.[Results]All the patients had operation performed successfully.At the latest follow up,the VAS and JOA scores significantly improved compared with those preoperatively(P<0.05),while the cervical range of motion remained unchanged significantly(P>0.05).[Conclusion]This unilateral open-door laminoplasty combined with reattachment of posterior muscle does effectively relieve the clinical symptoms,avoid postoperative head-up weakness,and achieve satisfactory clinical outcomes for upper cervical OPLL.

关 键 词：上颈椎 后纵韧带骨化症 单开门椎管成形术 肌肉重附着 

分 类 号：R681.55[医药卫生—骨科学]