前后路手术与单纯前路或后路手术治疗颈椎孤立型后纵韧带骨化症的比较研究

A comparative study of single anterior or posterior approach and one stage combined anterior and posterior approach for isolated ossification of the posterior longitudinal ligament

中文关键词:  后纵韧带骨化症  手术入路  JOA改善率  并发症

英文关键词:Ossification of the posterior longitudinal ligament  Surgical approach  Improvement rate of JOA score  Complications

中文摘要:

  【摘要】 目的：比较前、后路及前后路一期手术治疗颈椎孤立型后纵韧带骨化症的疗效及术中并发症的发生率。方法：回顾性分析2000年6月～2009年6月收治的69例诊断为颈椎孤立型后纵韧带骨化症并行手术治疗患者的临床资料。患者均有四肢肌力降低，双下肢行走不稳，双上肢精细动作功能减退，双下肢肌张力高，膝腱反射亢进，双侧Hoffman′s征阳性等锥体束受损的症状及体征，且颈椎CT及MRI检查均显示为孤立型后纵韧带骨化。根据手术方式不同将所有患者分成3组：Ⅰ组25例，行单纯颈前路减压椎间融合内固定术，术中从前路减压，切除骨化的后纵韧带；Ⅱ组22例，行单纯颈后路单开门椎管扩大成形术；Ⅲ组22例，行一期颈椎前后路联合手术（先行颈后路单开门椎管扩大成形术，然后再行前路减压内固定术）。比较硬脊膜破损发生率及双下肢无力的发生率，应用日本骨科学会（JOA）评分标准评价术后3组患者的JOA评分改善率。结果：Ⅰ、Ⅱ、Ⅲ组的术中硬脊膜破损率分别为32%、0、4.5%，术后双下肢无力的发生率分别为24%、0、0，Ⅲ组明显低于Ⅰ组（P＜0.05）。所有病例均获得至少1年的随访，随访时间平均15.3个月。术后3个月时，Ⅰ、Ⅱ、Ⅲ组的JOA评分改善率分别为（40.0±3.4）％、（32.3±4.5）％和（44.6±5.4）％；末次随访时分别为（60.8±7.7）％、（52.6±12.1）％和（66.2±8.9）％，Ⅲ组的JOA评分改善率均明显高于Ⅰ组及Ⅱ组（P＜0.05）。结论：治疗颈椎孤立型后纵韧带骨化症，行一期前后路联合手术近期疗效优于单纯颈前路及颈后路手术，且并发症发生率较低。

英文摘要:

  【Abstract】 Objectives: To compare the outcomes and complications of single anterior or posterior approach and one stage combined anterior and posterior approach for isolated ossification of the posterior longitudinal ligament(OPLL). Methods: In this study a retrospective review was performed on 69 patients with OPLL admitted to our hospital from June 2000 to June 2009. All those patients had impairment of pyramidal system including: weakness of extremities, gait disturbance, clumsiness of upper extremities, hypermyotonia, deep-tendon hyperreflexia and the positive Hoffman′s sign, and all patients presented with typical isolated OPLL in CT and MRI. According to 3 different operation approaches, all patients were divided into 3 groups: 25 patients(group Ⅰ) experienced anterior cervical decompression and fusion for direct dessect of the ossified ligament, 22 patients(group Ⅱ) experienced posterior unilateral open-door laminoplasty, and 22 patients(group Ⅲ) experienced one stage combined anterior and posterior operation(posterior unilateral laminoplasty followed by anterior cervical decompression and fusion). Incidence of dura mater torn and weakness of lower extremities during or after operation and the improvement rate of the JOA score after operation were observed in this study. Results: The incidence of dura mater torn during operation was 32%, 0% and 4.5% in group Ⅰ, Ⅱ and Ⅲ respectively, and weakness of lower extremities was 24%, 0 and 0 in group Ⅰ, Ⅱ and Ⅲ respectively. Compared with group Ⅰ, the incidences of both dura mater torn and weakness of lower extremities in group Ⅲ were significantly lower(P<0.05). All patients were followed up for more than 1 year(average, 15.3 months). Three months after operation, the improvement rate of JOA sore was (40.0±3.4)%, (32.3±4.5)% and (44.6±5.4)% respectively in three groups, and at final follow-up was (60.8±7.7)%, (52.6±12.1)% and (66.2±8.9)% respectively. Improvement rate of JOA sore in group Ⅲ was significantly higher than that in group Ⅰ and group Ⅱ(P<0.05). Conclusions: One stage combined anterior and posterior approach is effective of low incidence of complication for isolated OPLL, which is superior than single anterior or posterior approach.