C2穹隆减压术联合棘突悬吊椎管扩大成形术治疗颈椎高位后纵韧带骨化症  

C2 dome-shaped sublaminar decompression combined with spinous process suspension expansive laminoplasty for the treatment of high-cervical ossification of the posterior longitudinal ligament

作　　者：王晓岩 徐公平[1] 王新涛[1] 王玉玞[1] 奚春阳[1] 姬烨[1] 夏景君[1] 周磊[1] 由长城[1] 刘晓奇 祖佳宁[1] 庄金鹏[1] 周长龙 赵伟[1] 闫景龙[1] WANG Xiaoyan;XU Gongping;WANG Xintao;WANG Yufu;XI Chunyang;JI Ye;XIA Jingjun;ZHOU Lei;YOU Changcheng;LIU Xiaoqi;ZU Jianing;ZHUANG Jinpeng;ZHOU Changlong;ZHAO Wei;YAN Jinglong(Department of Orthopaedics,the Second Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第二医院骨外科,哈尔滨150001

出　　处：《中华骨与关节外科杂志》2024年第12期1057-1062,共6页Chinese Journal of Bone and Joint Surgery

基　　金：黑龙江省自然科学基金(LH2021H029)。

摘　　要：目的:分析C2穹隆减压术联合棘突悬吊单开门椎管扩大成形术治疗颈椎高位后纵韧带骨化症(OPLL)患者的疗效,同时进一步探讨K线对其疗效的影响。方法:回顾性分析2020年1月至2022年3月在哈尔滨医科大学附属第二医院行C2穹隆减压术联合棘突悬吊单开门椎管扩大成形术的颈椎高位OPLL患者的临床资料。其中男13例,女7例,年龄42~73岁,平均(54.7±7.5)岁。比较术前与末次随访时患者颈椎日本骨科协会(JOA)评分、颈部疼痛视觉模拟评分(VAS)及颈椎曲度。结果:本组20例患者随访时间4~22个月,平均(12.0±6.6)个月。与术前相比,末次随访时颈椎JOA评分改善率为(72.9±7.3)%,颈部疼痛VAS评分差异无统计学意义(P>0.05);末次随访时患者C2~7 Cobb角、C2~7矢状面垂直轴(SVA)、T1斜坡角与术前比较差异均无统计学意义(P均>0.05)。术前5例患者K线阴性,15例患者K线阳性;末次随访时所有患者K线均为阳性。术前K线阴性组与K线阳性组患者术前、末次随访时颈部疼痛VAS评分及影像学指标差异均无统计学意义(P均>0.05)。结论:C2穹隆减压术联合棘突悬吊椎管扩大成形术是治疗颈椎高位OPLL的有效术式,可以有效避免颈椎后方韧带复合体尤其是C2半棘肌止点的损伤,明显改善患者神经功能而不会造成颈椎曲度的丢失,且不增加颈部轴性痛发生的概率,对于术前K线阴性的患者具有同样的治疗效果。Objective:To analyze the efficacy of C2 dome-shaped sublaminar decompression combined with spinous process suspension single open-door laminoplasty for the treatment of high-cervical ossification of the posterior longitudinal ligament(OPLL),and to further explore the influence of the K-line on surgical outcomes.Methods:A retrospective analysis was conducted on the clinical data from patients with high-cervical OPLL who underwent C2 dome-shaped sublaminar decompression combined with spinous process suspension single open-door laminoplasty at the Second Affiliated Hospital of Harbin Medical University from January 2020 to March 2022,including 13 males and 7 females,with an mean of 54.7±7.5(ranging 42-73)years.The preoperative and final follow-up Japanese Orthopaedic Association(JOA)scores,neck pain visual analog scale(VAS)scores and cervical curvatures were compared.Results:All patients were followed for 4 to 22 months,with a mean follow-up of 12.0±6.6 months.At the final follow-up,the JOA scores improved significantly by(72.9±7.3)%from baseline,while the changes in neck VAS scores were not statistically significant(P>0.05).The Cobb angles of C2-7,the C2-7 sagittal vertical axis(SVA),and the T1 slope angles at the final follow-up were not significantly different from the baseline values(all P>0.05).Five patients were K-line negative and 15 patients were K-line positive preoperatively,but all patients were K-line positive at the final follow-up.There were no statistically significant differences in preoperative or final follow-up neck VAS scores and radiological indices between the K-line negative group and the K-line positive group(all P>0.05).Conclusions:C2 dome-shaped sublaminar decompression combined with spinous process suspension expansive laminoplasty is an effective surgical procedure for high-cervical OPLL.It effectively prevents damage to the posterior ligament complex of the cervical spine,especially the C2 semispinalis muscle insertion,significantly improves neurological function while preserving cerv

关 键 词：颈椎 后纵韧带骨化症 C2穹隆减压术 棘突悬吊椎管扩大成形术 

分 类 号：R681.5[医药卫生—骨科学]