K线用于选择颈椎后纵韧带骨化症手术策略的回顾性分析

A retrospective analysis on the role of K-line in determining surgical strategy for cervical ossification of posterior longitudinal ligament

中文关键词:  后纵韧带骨化症  脊髓病  K线  手术方式

英文关键词:Ossification of posterior longitudinal ligament  Myelopathy  K-line  Surgical approach

中文摘要:

  【摘要】 目的：验证颈椎侧位X线片上C2与C7椎管中点的连线（K线）用于颈椎后纵韧带骨化症（ossification of posterior longitudinal ligament，OPLL）手术方式选择的作用。方法：2000年5月至2008年4月，我科通过后路减压手术治疗颈椎OPLL引起的脊髓病患者35例，男25例，女10例，手术时平均年龄为54.6岁（35~73岁）。根据OPLL范围相对于K线的位置，将所有患者分为两组，OPLL范围未超过K线者为K线阳性组，超过K线者为K线阴性组。记录术前及术后1年时两组患者的日本骨科学会（Japanese Orthopedic Association，JOA）评分，算出恢复率。结果：K线阳性组24例，K线阴性组11例。K线阳性组的JOA评分由术前平均8.6分提高到术后1年时的13.8分，平均提高5.2分；K线阴性组由术前的6.6分提高到术后1年时的9.8分，平均提高3.2分；K线阳性组的平均恢复率为64.2%，K线阴性组为30.8%，两组间有非常显著性差异（P<0.001）。结论：术前利用K线这一简单实用的指标能有效预测OPLL后路减压手术的疗效，从而帮助医生选择合适的手术方式。

英文摘要:

  【Abstract】 Objective：To verify the role of the line connecting the midpoints of spine canal at C2 and C7 on lateral radiograph（K-line） on determining surgical strategy for cervical ossification of posterior longitudinal ligament（OPLL）.Method：From May 2000 to April 2008，35 patients（25 males and 10 females） suffered from cervical myelopathy due to OPLL underwent posterior decompression and laminectomy were reviewed retrospectively.The mean age at surgery was 54.6 years old（range，35-73 years old）.All patients were classified into 2 groups according to their K-line relating to the range of OPLL，K-line positive（OPLL beyond K-line） and K-line negative（OPLL not beyond K-line）.The Japanese Orthopedic Association scores before surgery and 1 year after surgery were recorded，and the improve rate was calculated.Result：24 patients were classified as K-line（+），and 11 patients as K-line（-）.The JOA score of K-line（+） group improved from pre-operative 8.6 to 13.8 at 1 year after operation，with an average improvement of 5.2.The score of K-line（-） group increased from pre-operative 6.6 to 9.8 at 1 year after operation，with the mean improvement of 3.2.The mean JOA improve rate was 64.2% for the K-line（+） group and 30.8% for the K-line（-） group（P<0.001）.Conclusion：As a simple and practical index，the K-line can effectively predict the surgical outcome of posterior decompression for cervical OPLL and therefor is useful for surgeons to determine the appropriate surgical strategy.