老年重度颈椎节段型后纵韧带骨化症的手术疗效

Analysis on surgical treatment for elderly patients with severe cervical segmental ossification of the posterior longitudinal ligament

中文关键词:  后纵韧带骨化症  颈椎  老年人  手术  疗效

英文关键词:Ossification of the posterior longitudinal ligament  Cervical  The elderly  Surgery  Efficacy

中文摘要:

  【摘要】 目的：总结老年重度颈椎节段型后纵韧带骨化症（OPLL）患者的手术治疗效果。方法：2006年1月~2011年7月经手术治疗的重度节段型颈椎OPLL老年患者48例，男33例，女15例；年龄60~86岁，平均71.33±8.46岁，病程4~16年，平均6.61±1.26年；病变节段≤2个椎体；颈椎曲度3.88°±5.14°；椎管狭窄率（58.77±4.32）%；JOA评分8.42±1.23分。根据术前情况将患者分为3组，A组（手术耐受力较差）：11例，男8例，女3例，采用单纯后路椎板切除减压内固定术；B组（MRI示颈髓无高信号）：18例，男13例，女5例，术前MRI T2像颈髓无明显高信号改变且无明显黄韧带肥厚者，采用单纯前路椎体次全切除减压+钛网植骨融合+钛钉板内固定术；C组（MRI示颈髓高信号）：19例，男12例，女7例，术前MRI T2像显示颈髓内均有明显高信号，其中10例合并明显黄韧带肥厚对颈髓形成“夹持型“压迫，采用后路椎板切除减压加前路椎体次全切除减压+钛网植骨融合+钛钉板系统内固定。每组术前、术后及术后1年随访时进行JOA评分、测量颈椎曲度，并观察手术并发症发生情况。结果：3组患者均顺利完成手术。A组2例术后出现轴性颈后疼痛，经非甾体抗炎药等对症处理逐渐缓解。B组2例发生脑脊液漏，其中1例自行愈合，1例经腰椎穿刺引流处理后愈合；3例术后当天出现神经功能恶化，经激素和营养神经等治疗后，均于术后7~22d恢复到术前水平并继续好转。C组1例出现切口红肿，但无脓肿形成，经抗生素治疗后愈合。3组患者术后JOA评分和颈椎曲度均有一定改善，术后和1年随访时与术前比较均有显著性差异（P＜0.05），术后1年JOA评分较术后进一步改善，差异有显著性（P<0.05）；A、B和C组术后1年随访时JOA评分改善率分别为（41.00±10.58）%、（55.20±10.66）%和（67.42±9.41）%；但3组术后1年颈椎曲度与术后比较无显著性差异（P>0.05）。结论：老年重度节段型OPLL患者，根据具体情况选择适当的手术方式，可有效改善神经功能。

英文摘要:

  【Abstract】 Objectives： To analyze the efficacy of different surgical procedures for elderly patients with severe segmental cervical ossification of the posterior longitudinal ligament(OPLL). Methods: 48 elderly patients severe legmental cervical OPLL were analyzed retrospectively. The patients underwent surgical treatment, including 33 males, 15 females; with an average age of 71.33±8.46 years(rang, 60-86 years); with an average course of duration of 6.61±1.26 years(rang, 4-16 years). The rang of lesion segments was 1 to 2; the mean cervical lordosis, spinalstenosis rate and JOA score was 3.88°±5.14°, (58.77±4.32)% and 8.42±1.23, repectively. According to the patient′s condition before surgery all patients were divided into three groups. Group A(poor tolerance to surgery) included 11 cases, 8 males, 3 females, which was used the simple posteriorlaminectomy decompression lateral mass screw fixation; group B[(without high-signal intensity zone(HIZ) on MRI)] included 18 cases, 13 males and 5 females who had no intramedullary HIZ on MRI and no obvious hypertrophy of ligamentum flavum, which was applied the simple anterior corpectomy decompression and interbody fusion and titanium screw-plate fixation; group C(with HIZ on MRI) included 19 cases, 12 males and 7 females who had significantly intramedullary HIZ found on MRI, or accompanied by obvious hypertrophy of ligamentum flavum, formed "clamp" oppression to the cervical spinal cord which was adopted the posterior and anterior corpectomy decompression and titanium mesh interbody fusion titanium screw-plate fixation. The change of cervical curvature, spinal stenosis rate, JOA score at pre- and post-operation and 1-year follow-up were compared. Occurrence of complications was analyzed. SPSS 16.0 software was used to compare and analyze the clinical efficacy. Results: All patients were successfully operated in three groups. Axial neck pain occurred gradually in 2 cases in group A, but the symptoms gradually ease after being treated by non-steroidal anti-inflammatory drugs. In group B, there were 2 cases suffered from CSF leakage, which 1 case resolved by self-healing, other 1 case resolved by lumbar puncture and drainage processing. 3 cases suffered from postoperative neurological deterioration who were resolved gradually to preoperative levels in postoperative 7-22 days and continued to improve by hormones and neurotrophic treatment. In group C, 1 case suffered from incision redness, but no abscess formation, and healed after antibiotic treatment. There was a significant improvement of cervical curvature and JOA score at postoperation and 1-year follow-up respectively, which showed statistical significance compared with preoperative ones(P<0.05). The JOA score improving rate in group A, B and C at 1-year follow-up was (41.00±10.58)%, (55.20±10.66)% and (67.42±9.41)%, respectively. But the cervical curvature at 1-year follow-up showed no significant difference compared with postoperative one(P>0.05). Conclusions: For elderly patients with severe OPLL, the surgical approach should be considered based on the individual conditions, which can ensure effective improvement of neurological function.