选择性颈后路单开门椎管扩大椎板成形术治疗孤立型颈椎后纵韧带骨化症的临床疗效

Clinical outcome of selective cervical posterior single open-door laminoplasty in the treatment of isolated cervical ossification of the posterior longitudinal ligament

中文关键词:  后纵韧带骨化症  孤立型  选择性颈后路单开门椎管扩大椎板成形术  颈前路椎体次全切术  临床疗效

英文关键词:Ossification of the posterior longitudinal ligament  Isolated  Selective cervical posterior single open-door laminoplasty  Anterior cervical corpectomy and fusion  Clinical outcome

中文摘要:

  【摘要】 目的：探讨选择性颈后路单开门椎管扩大椎板成形术治疗孤立型颈椎后纵韧带骨化症（ossification of the posterior longitudinal ligament，OPLL）的临床疗效，并与颈前路椎体次全切手术（anterior cervical corpectomy and fusion，ACCF）临床疗效进行比较。方法：回顾性分析2017年1月~2019年1月接受手术治疗且符合入组标准的40例孤立型颈椎OPLL患者的临床资料，其中行ACCF手术22例（ACCF组），行选择性颈后路单开门椎管扩大椎板成形术18例（LP组）。均获得12~24个月随访（ACCF组18.50±4.20个月，LP组18.60±4.50个月）。比较两组患者术前、术后3个月、末次随访时日本骨科协会（Japanese Orthopaedic Association，JOA）评分及颈痛视觉模拟评分（visual analogue score，VAS），比较两组患者末次随访时的神经功能改善率；比较两组患者术前、末次随访时颈椎曲度、颈椎活动度；比较两组患者手术出血量、手术时间、术后住院时间及术后并发症发生率的差异。结果：ACCF组患者手术时间为142.50±7.52min、手术出血量为379.32±65.14ml、术后住院时间为8.77±1.51d，LP组分别为129.06±10.58min、240.00±53.69ml、7.83±1.34d，LP组均明显少于ACCF组（P<0.05）。两组患者术后3个月、末次随访时的JOA评分较术前均明显升高，VAS评分较术前均明显降低，差异均有统计学意义（P<0.05）；但术前、术后3个月及末次随访时两组之间的JOA评分和VAS评分比较均无统计学差异（P>0.05）；末次随访时ACCF组神经功能改善率为（65±9）%，LP组为（61±15）%，两组比较无统计学差异（P>0.05）。ACCF组术前颈椎曲度9.77°±1.23°，末次随访时11.05°±1.25°；LP组术前10.33°±1.33°，末次随访时11.44°±1.46°，术前、末次随访时组间比较均无统计学差异（P>0.05），两组末次随访时较术前均明显提高（P<0.05）。ACCF组术前颈椎活动度38.18°±2.26°，末次随访时29.05°±2.17°；LP组术前38.17°±2.09°，末次随访时32.44°±2.15°，术前两组间比较无统计学差异（P>0.05），末次随访时ACCF组较LP组降低更明显（P<0.05），两组末次随访时较术前均降低（P<0.05）。LP组术后并发症发生率为22.2%，ACCF组为54.5%，LP组明显低于ACCF组（P<0.05），其中LP组术后出现轴性症状2例，左侧C5神经根麻痹1例，轻度后凸畸形1例；ACCF组钛网下沉3例，食管牵拉伤1例，喉返神经麻痹2例，硬膜外血肿1例，硬脊膜漏2例，邻近节段退变3例。结论：选择性颈后路单开门椎管扩大椎板成形术与ACCF治疗孤立型颈椎OPLL，短期内在改善颈脊髓神经功能上无明显差异；选择性颈后路单开门椎管扩大椎板成形术在术中出血量、手术时间、术后住院时间、颈椎活动度的维持及术后并发症发生率方面较ACCF更具优势。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical effect of selective cervical posterior single open-door laminoplasty in the treatment of isolated cervical ossification of the posterior longitudinal ligament(OPLL), and compare it with the clinical outcome of anterior cervical corpectomy and fusion(ACCF). Methods: A retrospective study was performed on 40 isolated cervical OPLL patients receiving surgery from January 2017 to January 2019. 22 patients underwent ACCF surgery as the ACCF group, and 18 patients underwent selective cervical posterior single open-door laminoplasty as the LP group. All patients were followed up for 12 to 24 months. The follow-up time was 18.50±4.20 months in the ACCF group and 18.60±4.50 months in the LP group. The JOA scores and neck pain VAS scores were compared between the patients of the two groups at preoperative, 3 months postoperative and final follow-up. The neurological improvement rate(IR) at final follow-up was compared between the patients of both groups. The cervical curvature change and cervical range of motion(ROM) at preoperative and final follow-up were compared between the two groups. The differences of intraoperative blood loss, operative time, length of postoperative hospital stay and postoperative complication rate between the two groups were compared. Results: The operation time, the intraoperative blood loss and length of postoperative hospital stay of ACCF group and LP group were 142.50±7.52min, 379.32±65.14ml, 8.77±1.51d, and 129.06±10.58min, 240.00±53.69ml, 7.83±1.34d respectively, with that of LP group significantly less than ACCF group(P<0.05). Both groups saw a significantly higher JOA score at 3 months after surgery and final follow-up than at preoperative(P<0.05), and a significantly lower VAS score at 3 months after surgery and final follow-up than at preoperative(P<0.05). Whereas, there was no significant difference in JOA score and VAS score between the two groups at preoperative, 3 months postoperative and final follow-up(P>0.05). The neurological IR in ACCF group at final follow-up was (65±9)%, and that in LP group was (61±15)%. There was no statistically significant difference in the neurological IR between the two groups at final follow-up(P>0.05). The cervical curvature in the ACCF group was 9.77°±1.23° before operation, and 11.05°±1.25° at final follow-up. The cervical curvature in LP group was 10.33°±1.33° before operation, and 11.44°±1.46° at final follow-up. There was no significant difference in the cervical curvature between the two groups(P>0.05). At final follow-up, the cervical curvature of the two groups was significantly improved compared with that before surgery, and the differences were statistically significant(P<0.05). In ACCF group, the cervical ROM at preoperative was 38.18°±2.26°, and at tfinal follow-up it was 29.05°±2.17°. The cervical ROM before surgery was 38.17°±2.09°, and at final follow-up it was 32.44°±2.15°. The comparison of cervical ROM before surgery between the two groups has no statistical significance(P>0.05), and that in ACCF group reduced more significantly at final follow-up(P<0.05). In final follow-up, the cervical ROM of the two groups was significantly reduced compared with that before surgery, and the differences were statistically significant(P<0.05). In LP group, 2 cases presented axial symptoms, 1 case presented left C5 nerve root paralysis, and 1 case presented mild kyphosis. In the ACCF group, there were 3 cases of titanium cage subsidence, 1 case of esophageal traction injury, 2 cases of recurrent laryngeal nerve paralysis, 1 case of epidural hematoma, 2 cases of dural leakage, and 3 cases of adjacent segment degeneration. The incidence of postoperative complications was 22.2% in the LP group and 54.5% in the ACCF group. The incidence of postoperative complications in the LP group was significantly lower than that in the ACCF group, with statistically significant difference(P<0.05). Conclusions: There was no significant difference in short-term prognosis in the treatment of isolated cervical OPLL between selective cervical posterior single open-door laminoplasty and ACCF; In terms of surgical bleeding volume, operative time, postoperative hospital stay, maintenance of cervical ROM, and postoperative complication rate, selective cervical posterior single open-door laminoplasty has more advantages than ACCF.