颈椎病前路手术切除后纵韧带的适应证及意义

Indication of resection of posterior longitudinal ligament in anterior decompression for cervical spondylotic myelopathy

中文关键词:  颈椎病  前路手术  后纵韧带切除

英文关键词:Cervical spondylosis  Anterior operation  Posterior longitudinal ligament resection

中文摘要:

  【摘要】 目的：探讨脊髓型颈椎病前路手术中后纵韧带切除的适应证及意义。方法：2000年6月~2010年6月我院行颈椎前路减压植骨融合内固定手术治疗脊髓型颈椎病患者500例，其中213例患者切除后纵韧带，男153例，女60例，年龄30~74岁，平均49.96岁。回顾分析患者的临床资料和治疗效果。结果：术中切除后纵韧带的213例中，178例术前影像学有相应的后纵韧带或椎间盘钙化；30例术中探查后纵韧带弹性差、有韧或硬感；1例术前MRI显示椎间盘突出到硬膜内，周围有脑脊液信号；4例术中发现后纵韧带上有破损，切除后纵韧带后发现椎间盘突出到后纵韧带后方、硬膜囊前方。术后并发脑脊液漏患者3例，经保守治疗后治愈；早期出现硬膜外血肿致神经症状加重2例，均及时发现，手术清除血肿，神经功能在1个月内恢复；术后并发食管损伤者2例，经保守治疗，均在4~6周愈合。随访6~70个月，平均36.7个月，JOA评分由术前4~14分，平均8.71±3.36分，提高到随访时的5~17分，平均13.50±3.50分，差异有显著性（P<0.05）；改善率为7.69%~100%，平均60.0%。结论：根据术前影像学及术中探查时后纵韧带的弹性可以决定颈椎病前路手术是否需要切除后纵韧带，切除后纵韧带时会发生一些并发症，应严格把握适应证，术中谨慎操作。

英文摘要:

  【Abstract】 Objectives: To discuss the indication of resection of posterior longitudinal ligament(PLL) during the anterior decompression for cervical spondylotic myelopathy. Methods: 500 patients with cervical spondylotic myelopathy treated anteriorly from June 2000 to June 2010 were retrospectively reviewed. Resection of PLL was performed in 213 cases, including 153 males and 60 females with a mean age of 50 years(range, 30-74 years). Clinical data and outcome were analyzed. Results: Among the 213 cases, calcification of the posterior longitudinal ligament or disc was found in 178 cases. Loss of elasticity was noted during the operation in 30 cases. The disc herniation was found penetrated into the dual matter in 1 case, which surrounded by the signal of cerebrospinal fluid, and not penetrating the the dual in 4 cases, all these were found during the operation. 3 cases suffered from postoperative cerebrospinal fluid leakage, which was cured by conservative treatment. 2 cases were complicated with epidural hematoma which led to neurological deficit and was resolved 1 month later by immediate reoperation. 2 cases suffering from esophageal injury were cured by conservative treatment for 4-6 weeks. All cases were followed up for 36.7 months(range, 6-70 months). The improvement rate was 60.00% (range, 7.69%-100%). JOA score improved from 8.71±3.36(range, 4-14) to 13.50±3.50(range, 5-17). There was significant difference of JOA score between pre- and postoperation(P<0.05). Conclusions: Preoperative characteristics in radiograph and intraoperative palpation of PLL can be used to determine the necessity of resection of PLL, complications may be encountered during this procedure, which should be paid attention.