颈前路可控前移融合术治疗后纵韧带骨化症所致颈椎管狭窄的疗效  

Efficacy of anterior controllable ante-displacement and fusion surgery for cervical spinal stenosis due to ossification of the posterior longitudinal ligament

作　　者：菅强 张博彦 菅凤增[1] 陈赞[1] JIAN Qiang;ZHANG Boyan;JIAN Fengzeng;CHEN Zan(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中华骨与关节外科杂志》2024年第3期200-206,共7页Chinese Journal of Bone and Joint Surgery

基　　金：促进市级医院临床技能与临床创新能力三年行动计划项目(2020—2022年)(SHDC2020CR1024B)。

摘　　要：目的:探讨应用颈前路可控前移融合术(ACAF)治疗后纵韧带骨化症(OPLL)所致颈椎管狭窄的疗效。方法:回顾性分析2019年7月至2020年9月采用ACAF治疗的17例OPLL所致颈椎管狭窄患者的临床资料。其中男12例,女5例,年龄46~79岁,平均(60.0±12.2)岁。术前及末次随访时在颈椎侧位X线片上测量C2~C7 Cobb角,在CT轴位像横突孔节段上测量手术节段的有效椎管矢状径、有效椎管面积,同时应用颈椎日本骨科协会(JOA)评分、疼痛视觉模拟评分(VAS)评估神经功能、疼痛情况。结果:17例患者共前移椎体41个。1例患者出现椎动脉损伤;1例患者因ACAF手术提拉不足再次行后路椎板切除术;其余15例患者术中无神经和硬脊膜损伤发生。所有17例患者切口均一期愈合,无感染发生。随访15~28个月,平均(21.4±4.8)个月。末次随访时,C2~C7 Cobb角由术前的8.9°±8.0°增加到19.7°±3.8°,有效椎管矢状径由术前的(6.7±2.0)mm增加到(11.5±2.7)mm,有效椎管横截面积由术前的(13.2±5.1)mm2增加到(22.5±5.3)mm2。末次随访时,颈椎JOA评分改善率为66.7%(37.5%,100%),疼痛VAS评分改善率为80.0%(50.0%,100%)。椎管减压充分,置入内固定稳定,未见螺钉松动及移位。结论:应用ACAF可以有效治疗OPLL所致颈椎管狭窄,获得满意的临床疗效。Objective:To investigate the efficacy of anterior controllable ante-displacement and fusion surgery(ACAF)for cervical spinal stenosis caused by ossification of the posterior longitudinal ligament(OPLL).Methods:The clinical data of 17 patients with cervical spinal stenosis caused by OPLL who underwent ACAF from July 2019 to September 2020 were retrospectively analyzed.There were 12 males and 5 females,aged 46-79 years,with an average age of(60.0±12.2)years.Preoperative and final follow-up measurements included C2-7 Cobb angle on lateral cervical spine X-rays,measurements of the effective sagittal diameter and effective spinal canal area at the surgical segments on axial CT images at the level of the transverse foramen,and assessments of neurological function and pain using the Japanese Orthopedic Association(JOA)score and visual analogue scale(VAS),respectively.Results:Among the 17 patients,anterior displacement of 41 vertebral bodies was observed.Vertebral artery injury occurred in 1 patient,and posterior laminectomy was performed again in another patient due to insufficient decompression of ACAF.No neural or dural injuries were observed intraoperatively in the remaining 15 patients.All 17 patients achieved primary wound healing without infection.The mean follow-up duration was(21.4±4.8)months.At the final follow-up,the Cobb angle increased from 8.9°±8.0°preoperatively to 19.7°±3.8°,the effective sagittal diameter of spinal canal increased from(6.7±2.0)mm to(11.5±2.7)mm,and the effective crosssectional area of spinal canal increased from(13.2±5.1)mm2 to(22.5±5.3)mm2.The improvement rate of cervical JOA was 66.7%(37.5%,100%),and the improvement rate of pain VAS score was 80.0%(50.0%,100%).Decompression of the spinal canal was adequate and internal fixation was stable without screw loosening or displacement.Conclusions:ACAF surgery can effectively treat OPLL-associated cervical spinal stenosis,achieving satisfactory clinical outcomes.

关 键 词：颈前路可控前移融合术 颈椎管狭窄 后纵韧带骨化症 

分 类 号：R681.5[医药卫生—骨科学]