单开门颈椎管扩大椎板成形术治疗颈椎后纵韧带骨化症的中远期疗效观察

The mid-to-long term efficacy of open-door laminoplasty for cervical ossification of posterior longitudinal ligament

中文关键词:  颈椎后纵韧带骨化症  椎板成形术  疗效

英文关键词:Cervical ossification of posterior longitudinal ligament  Laminoplasty  Outcome

中文摘要:

  【摘要】 目的：评估单开门颈椎管扩大椎板成形术治疗颈椎后纵韧带骨化症（OPLL）的中远期临床疗效。方法：回顾性分析2005年3月～2012年4月在北京大学第三医院接受单开门颈椎管扩大椎板成形术的44例颈椎OPLL患者。其中，男26例，女18例；年龄57.1±8.5岁（28～72岁）；术前改良JOA 17分法评分为11.39±3.27分（1.5～16分），颈痛VAS评分为2.32±2.59分（0~10分）。OPLL骨块累及3.20±1.64个（1～6个）椎体节段，骨块的椎管侵占率为（46.05±13.67）%（22%～72%）。手术范围：C3~C7 34例，C2~C7 7例，C2~C6 3例。术前及末次随访时分别测量颈椎侧位X线片上颈椎整体曲度及曲度指数、颈椎MRI中矢状位T2加权像C2/3~C6/7各节段脊髓整体后移距离（PCS）、脊髓前缘后移距离（PAS）、脊髓膨胀度（ESC）。结果：所有患者均获得随访，随访36.8±16.8个月（24～96个月）。末次随访时，JOA评分为14.70±1.96分（9.5~17分），颈痛VAS评分为3.59±2.97分（0~10分），与术前比较均有统计学差异（P<0.05）。末次随访时JOA评分改善率为（57.59±30.88）%，其中神经功能恢复为优者12例，良19例，不理想13例，优良率为70.45%。末次随访时的颈椎曲度指数、颈椎整体曲度与术前比较无统计学差异（P>0.05）。末次随访时，C2/3~C6/7各节段脊髓均有明显后移、脊髓前后径增加，PCS及PAS在C3/4~C6/7节段均明显高于C2/3节段（P<0.05）；而ESC在C3/4~C5/6节段明显高于C2/3及C6/7节段（P<0.05）。10例患者末次随访时（术后2~8年）观察到OPLL骨块继续生长。结论：单开门颈椎管扩大椎板成形术治疗颈椎OPLL可获得脊髓症状的中长期缓解，但轴性症状较术前加重。减压节段的头端脊髓后移及膨胀程度幅度较小，应注意保证该节段的充分减压。

英文摘要:

  【Abstract】 Objectives: To investigate the mid-to-long term clinical and radiological outcome of open-door laminoplasty for the cervical ossification of posterior longitudinal ligament(OPLL). Methods: A retrospective study was performed on 44 cervical OPLL patients receiving open-door laminoplasty from March 2005 to April 2012. There were 26 males and 18 females with an average age of 57.1 years old(range, 28-72 years). Preoperative modified JOA score was 1.5-16(11.39±3.27), and neck pain VAS score was 0-10(2.32±2.59). The average levels of OPLL were 3.2(range, 1-6 levels). The surgery level included: C3-C7 in 34 cases, C2-C7 in 7 cases, C2-C6 in 3 cases. Clinical outcome was evaluated by means of JOA score and axial symptoms VAS score. Radiological outcomes such as cervical curvature and curvature index on lateral radiographs, the posterior shift of center of spinal cord(PCS), posterior shift of the anterior margin of spinal cord(PAS) and the expansion of spinal cord(ESC) of each level from C2/3 to C6/7 on mid-sagittal images of MRI T2-weighted were recorded. Results: The follow-up period ranged from 24 to 96 months with an average of 36.8 months. The JOA score significantly improved from 11.39±3.27 preoperatively to 14.70±1.96(P<0.05) at final follow-up with an improving rate of (57.59±30.88)%. The VAS score for axial symptoms increased slightly from 2.32±2.59 preoperatively to 3.59±2.97 at final follow-up. Cervical curvature and curvature index remained unchanged(P>0.05). The PCS and PAS were more severe at C3/4 to C6/7 levels than C2/3(P<0.05). The ESC was more severe at C3/4 to C5/6 levels than C2/3 and C6/7(P<0.05). The progression of OPLL was observed in 10 cases at final follow-up(range, 2-8 years after surgery). Conclusions: The open-door laminoplasty for cervical OPLL has a satisfactory mid-to-long term neurofunction improvement, but axial symptoms deteriorate. Since the posterior shift and expansion of the cephalic spinal cord are less than the others, complete decompression should be considered.