前路椎体骨化物复合体可控前移技术治疗颈椎后纵韧带骨化症的脊髓原位减压效果

Effect of in situ decompression during anterior controllable antedisplacement fusion for treatment of the cervical ossification of posterior longitudinal ligament

中文关键词:  颈椎前路椎体骨化物复合体可控前移技术  原位减压  后纵韧带骨化症  C5神经麻痹

英文关键词:Anterior controllable antedisplacement fusion  In situ decompression  Ossification of the posterior longitudinal ligament  C5 nerve palsy

中文摘要:

  【摘要】 目的：观察颈椎前路椎体骨化物复合体可控前移（anterior controllable antedisplacement fusion，ACAF）技术治疗颈椎后纵韧带骨化症（ossification of the posterior longitudinal ligament，OPLL）的脊髓原位减压效果。方法：回顾分析2017年6月～2018年12月我院收治的78例OPLL患者的人口学信息、影像资料以及术后指标（年龄、性别、症状持续时间、椎管侵占率和骨化累及椎体数量）。其中采用ACAF治疗42例，单开门椎管扩大椎板成形术（简称单开门椎板成形术open-door laminoplasty，LAM）治疗36例，平均随访时间21.7±4.0（12～30）个月。比较两组患者术前及末次随访时的JOA评分、脊髓面积、Cobb角、Kang′s分级以及C5神经麻痹、脑脊液漏、吞咽困难等并发症情况。结果：末次随访时，ACAF组与LAM组相比，在JOA评分（14.17±0.81分 vs 13.81±1.12分，P＜0.05）、脊髓面积（74.12±4.48mm2 vs 70.36±5.60mm2，P＜0.05）、Cobb角（20.07°±1.28° vs 9.99°±0.65°，P＜0.05）和Kang′s分级（0.93±1.40 vs 2.00±0.89，P＜0.05）方面具有优势。对比ACAF组与LAM组的术后并发症，两组间C5神经麻痹（4.8％ vs 11.1％）、脑脊液漏（2.4％ vs 2.8％）、吞咽困难（9.5％ vs 0％）无统计学差异。ACAF组2例出现C5神经麻痹的患者未能顺利完成原位减压。结论：ACAF手术可通过恢复椎管容积和形态实现脊髓原位减压，减压效果良好。在恢复颈椎曲度和脊髓位置形态方面，ACAF较LAM为优。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical effect of in situ decompression during anterior controllable antedisplacement fusion(ACAF) in treatment of cervicalossification of the posterior longitudinal ligament(OPLL). Methods: The demographic information, imaging data and postoperative indicators(age, sex, duration of symptom, occupying rate, and number of ossified vertebrae) from 78 patients diagnosed with OPLL were analyzed retrospectively. All patients were admitted from June 2017 to December 2018. 42 cases were treated with ACAF and 36 cases with open-door laminoplasty(LAM). The average follow-up time was 21.7±4.0(12-30) months. The JOA score, area of spinal cord, Cobb angle, Kang′s grade, and the incidences of C5 nerve palsy, cerebrospinal fluid leakage and dysphagia were compared between the two groups before operation and at final follow-up. Results: At final follow-up, compared with LAM group, ACAF group had advantages in JOA score(14.17±0.81 vs 13.81±1.12, P<0.05), area of spinal cord(74.12±4.48mm2 vs 70.36±5.60mm2, P<0.05), Cobb angle(20.07°±1.28° vs 9.99°±0.65°, P<0.05) and Kang′s grade(0.93±1.40 vs 2.00±0.89, P<0.05). The postoperative complications of ACAF and LAM group demonstrated C5 nerve palsy(4.8％ vs 11.1％), cerebrospinal fluid leakage(2.4％ vs 2.8％) and dysphagia(9.5％ vs 0％), there was no statistical difference between two groups. In ACAF group, 2 patients with C5 palsy failed to complete in situ decompression. Conclusions: ACAF can achieve in situ decompression to spinal cord by restoring the volume and shape of spinal canal, and the effect of decompression is significant. As to the recovery of cervical curvature and shape of spinal cord, ACAF is better than LAM.