前路或后路手术治疗颈椎后纵韧带骨化症的中期疗效观察

Anterior or posterior approaches for cervical ossification of posterior longitudinal ligament: a mid-term follow-up

中文关键词:  颈椎后纵韧带骨化症  手术  椎管狭窄率  中期随访

英文关键词:Ossification of the posterior longitudinal ligament  Cervical surgery  Canal stenosis ratio  Mid-term follow-up

中文摘要:

  【摘要】 目的：观察颈椎前路椎体次全切减压融合术（ACCF）和颈椎后路单开门椎管扩大成形术在治疗颈椎后纵韧带骨化症（OPLL）的中期临床疗效和影像学改善情况。方法：2010年1月~2012年12月我院收治33例颈椎OPLL患者，男17例，女16例；年龄41~78岁（58.6±8.8岁）。其中16例骨化块累及2个节段及以内者通过ACCF切除骨化块减压（A组）；17例骨化块累及2个节段以上、前路切除有困难者采用后路单开门椎管扩大成形术（B组）。所有患者术前、术后3个月、1年、2年、3年和末次随访时进行JOA评分。通过配对样本t检验分析两组患者术前、术后和末次时的JOA评分、颈椎曲度及椎管狭窄率的变化情况。结果：A组1例术后发生吞咽困难；B组1例发生脑脊液漏，1例发生切口感染。均经对症处理后痊愈。A组随访48.56±8.02个月，B组随访52.59±8.88个月。两组患者术后JOA评分均较术前有显著性改善（P<0.05）；术后和末次随访时颈椎曲度较术前无明显差异（P>0.05）；A组末次随访骨化块面积明显大于术后（P<0.05），B组末次随访骨化块面积较术后无明显差异（P>0.05）。结论：对于颈椎OPLL，ACCF和后路单开门椎管成形术均为有效且安全的术式，中期随访疗效满意。前者通过切除或“漂浮”骨化块达到有效减压；后者能够扩大椎管缓解脊髓压迫，中期随访椎管狭窄率维持稳定。

英文摘要:

  【Abstract】 Objectives: To observe the mid-term clinical outcomes and radiological parameters of anterior cervical corpectomy and fusion(ACCF) and posterior single-door laminoplasty in cervical ossification of posterior longitudinal ligament(OPLL). Methods: All 33 cervical OPLL cases(17 males, 16 females; mean age, 58.6±8.8 years; range, 41 to 78 years) treated in our department between January 2010 and December 2012 were analyzed retrospectively. 16 cases with less than 2 segments involved were treated by ACCF(group A). 17 cases with more than 2 segments involved were treated by the posterior single-door laminoplasty(group B). All patients included in the study had preoperative, postoperative cervical X-rays, CTs and MRIs. Japanese Or?鄄thopaedic Association(JOA) score was used to evaluate the clinical outcomes of the two groups. Curvature angle and canal stenosis rate before surgery and at the follow-up were analyzed. The clinical and radiographic differences between the two groups were compared by using the paired t-test. Results: The mean follow-up time in group A and B was 48.56±8.02 and 52.59±8.88 months, respectively. One case presented postoperative dysphagia in group A and recovered by self in the follow-up. One case occured cerebrospinal fluid leakage and one case occured postoperative wound infection in group B, they recovered by delayed drainage and placing drainage-tube respectively. The postoperative JOA score was significantly higher than the preoperative(P<0.05). Cervical curvature showed no significant difference(P>0.05) before surgery, at post operation immediately and the last follow-up. At the last follow-up, ossified mass area was significantly higher than the postoperative in group A(P<0.05), but not in group B(P>0.05). Conclusions: For cervical OPLL, the ACCF and posterior single-door laminoplasty appear to be efficient and safer approaches. Posterior single-door laminoplasty is able to enlarge the canal and relieve compression, and the canal stenosis rate can maintain stable through mid-term follow-up. ACCF surgery can decompress cervical canal stenosis better by removing ossified mass. And the clinical outcomes of two procedures are satisfying in early and middle term.