改良椎管扩大成形术治疗颈椎后纵韧带骨化症的10年随访结果  

Cervical ossification of posterior longitudinal ligament treated with modified laminoplasty:10-year follow-up

作　　者：吴昊森 周非非[1,2,3] 陈欣 张凤山[1,2,3] 潘胜发[1,2,3] 王少波 孙宇[1,2,3] WU Haosen;ZHOU Feifei;CHEN Xin;ZHANG Fengshan;PAN Shengfa;WANG Shaobo;SUN Yu(Department of Orthopaedics,Peking University Third Hospital,Beijing 100191;Engineering Research Center of Bone and Joint Precision Medicine,Ministry of Education,Beijing 100191;Beijing Key Laboratory of Spinal Disease Research,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科,北京100191 [2]骨与关节精准医学教育部工程研究中心,北京100191 [3]脊柱疾病研究北京市重点实验室,北京100191

出　　处：《中华骨与关节外科杂志》2024年第1期9-14,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:观察改良椎管扩大成形术(mLP)即颈后路保留一侧肌肉韧带复合体单开门椎管扩大成形术治疗颈椎后纵韧带骨化症(OPLL)的10年随访结果。方法:选择2006年1月至2012年12月接受mLP且完成10年以上随访、临床及影像学资料完整的33例颈椎OPLL患者进行回顾性分析。其中17例患者行mLP,13例患者行mLP联合颈前路固定融合术(11例患者行颈前路椎间盘切除固定融合术,2例患者行颈前路椎体切除固定融合术),3例患者行mLP联合后方侧块螺钉固定融合术。术前及末次随访时采用改良日本骨科学会(mJOA)评分、疼痛视觉模拟评分(VAS)及颈椎功能障碍指数(NDI)分别评估患者神经功能、颈痛程度及颈痛对颈椎功能及患者生活质量的影响,同时通过颈椎正侧位及过伸过屈位X线片测量颈椎曲度、颈椎活动度(ROM)及C2-7矢状面轴向距离(SVA)。结果:本组患者随访120~167个月,平均随访时间(134.6±11.4)个月。末次随访时患者mJOA评分较术前明显改善(P<0.001),而NDI及疼痛VAS评分与术前比较差异均无统计学意义(P均>0.05)。末次随访时14例患者(42.4%)仍存在轴性症状,但程度较轻,且无需药物治疗。所有患者术后均未出现C5神经根麻痹,且均未进行二次手术。接受mLP治疗的患者无论是否联合固定术式,末次随访时颈椎ROM及颈椎过伸位、过屈位曲度均较术前减小(P均<0.05),而SVA与术前比较差异均无统计学意义(P>0.05)。结论:mLP治疗颈椎OPLL术后10年在临床功能改善、颈部维持颈椎矢状面平衡方面均获得了较为满意的结果,但轴性症状的发生率仍较高。Objective:To observe the 10-year follow-up results of modified laminoplasty(mLP),namely the unilateral open-door laminoplasty with posterior muscle-ligament complex preservation,for cervical ossification of posterior longitudinal ligament(OPLL).Methods:A retrospective analysis was conducted on 33 cervical OPLL patients who underwent mLP from January 2006 to December 2012 and completed follow-ups of over 10 years with complete clinical and imaging data.Among them,17 patients underwent mLP alone,13 patients underwent mLP combined with anterior cervical fusion(11 patients with anterior cervical discectomy and fusion,and 2 patients with anterior cervical corpectomy and fusion),and 3 patients underwent mLP combined with posterior lateral mass screw fixation and fusion.The modified Japanese Orthopedic Association(mJOA)score,visual analog scale(VAS)and neck disability index(NDI)were used to evaluate the neurological function,neck pain severity and the impact of neck pain on cervical function and quality of life before surgery and at the final follow-up.Additionally,cervical curvature,range of motion(ROM)and C2-C7 sagittal vertical axis(SVA)were measured using cervical X-ray in neutral,lateral,and flexion-extension positions.Results:The patients were followed up for 120-167 months,with an average follow-up time of(134.6±11.4)months.At the final follow-up,there was a significant improvement in mJOA score compared to the preoperative score(P<0.001).However,there was no statistically significant difference in NDI score and neck pain VAS score compared to preoperative values(both P>0.05).At the final follow-up,14 patients(42.4%)still had axil syndromes,however,the severity was mild and no medication was required.No patients experienced C 5 nerve root palsy and reoperation.Patients treated with mLP,whether combined with fusion or not,showed a decrease in cervical ROM and curvature in hyperextension and hyperflexion positions at the final follow-up compared to preoperative values(all P<0.05),while SVA showed no statistically

关 键 词：颈椎 后纵韧带骨化症 椎管扩大成形术 长期随访 

分 类 号：R653[医药卫生—外科学]