不离断后纵韧带的前路椎体－骨化物复合体可控前移融合术治疗颈椎多节段后纵韧带骨化症的疗效

The clinical efficacy of anterior controllable antedisplacement and fusion with unsevered posterior longitudinal ligament in the treatment of multilevel cervical ossification of the posterior longitudinal ligament

中文关键词:  后纵韧带骨化症  多节段  椎体－骨化物复合体可控前移技术  手术疗效

英文关键词:Ossification of the posterior longitudinal ligament  Multilevel  Anterior controllable antedisplacement and fusion  Clinical efficacy

中文摘要:

  【摘要】 目的：评估不离断后纵韧带颈椎前路椎体－骨化物复合体可控前移融合术（anterior controllable antedisplacement and fusion，ACAF）治疗颈椎多节段后纵韧带骨化症（ossification of the posterior longitudinal ligament，OPLL）的手术疗效。方法：回顾性分析2017年10月~2019年11月在我院行ACAF治疗的多节段颈椎OPLL患者73例，其中采用不离断后纵韧带的ACAF治疗的42例纳入非离断组（男32例，女10例，年龄55.8±9.7岁，随访时间2.4±0.4年），采用离断后纵韧带的ACAF治疗的31例纳入离断组（男25例，女6例，年龄56.7±11.4岁，随访时间2.3±0.3年）。记录两组患者的手术时间、出血量、住院时间和手术相关并发症。在术前和术后12个月的颈椎CT上测量椎管占位率、前移距离（术后椎管前后径-术前椎管前后径）、减压宽度、椎管前后径，评估手术减压情况；在术后7d和12个月的颈椎正侧位、动力位X线片和CT上观察棘突间隙活动变化、融合器内外骨桥形成以及椎体间总高度，评估术后骨融合程度。术前和末次随访时对患者进行JOA评分并计算JOA改善率，评估神经功能恢复情况。结果：非离断组手术时间212.9±33.8min，出血量489.8±199.0ml，住院时间7.2±2.0d；离断组手术时间257.4±33.2min，出血量598.9±241.3ml，住院时间8.9±3.2d，两组间差异有统计学意义（P＜0.05）。术前、术后12个月的椎管占位率、减压宽度、前移距离和椎管前后径，两组间差异无统计学意义（P＞0.05）。非离断组术后12个月的骨融合率明显高于离断组[棘突间隙活动（92.9% vs 74.2%），融合器内外骨桥（88.1% vs 61.3%）]，差异有统计学意义（P＜0.05）。非离断组的总并发症发生率（9.5%）显著低于离断组（32.2%），差异有统计学意义（P＜0.05）。末次随访时JOA评分和神经功能改善率，两组间差异无统计学意义（P＞0.05）。结论：与离断后纵韧带相比，不离断后纵韧带的ACAF能够在保证减压效果的情况下，有效降低手术难度，减少手术时间、出血量和并发症，促进术后康复和骨融合。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical outcome of anterior controllable antedisplacement and fusion(ACAF) with unsevered posterior longitudinal ligament(PLL) for the treatment of multilevel cervical ossification of the posterior longitudinal ligament(OPLL). Methods: Data of 73 patients with multilevel cervical OPLL who underwent ACAF in our hospital from October 2017 to November 2019 were reviewed retrospectively. The patients were divided into the unsevered group(n=42, 32 males and 10 females, averaged 55.8±9.7 years old and 2.4±0.4 years of follow-up) and severed group(n=31, 25 males and 6 females, averaged 56.7±11.4 years old and 2.3±0.3 years of follow-up). The operative time, blood loss, length of hospital stay, and complications of the two groups of patients were collected. The occupying rate of spinal canal, antedisplacement distance, decompression width, and anteroposterior canal diameter were measured on CT images before and at 12 months postoperatively to evaluate the decompression. The interspinous motion, intra-and extragraft bone bridging and changes in the total interbody height of fused vertebral bodies were observed on cervical anteroposterior and lateral images, dynamic X-ray, and CT images at 7d and 12m postoperatively to evaluate the fusion. JOA scores were recorded before surgery and at the final follow-up to assess the recovery of neurologic function. Results: The unsevered group showed less operative time(212.9±33.8min vs 257.4±33.2min), blood loss(489.8±199.0ml vs 598.9±241.3ml) and length of hospital stay(7.2±2.0d vs 8.9±3.2d) than those of severed group(P<0.05). The preoperative and 12m postoperatively occupying rate, decompression width, antedisplacement distance, and anteroposterior canal diameter were not significantly different between the two groups(P>0.05). The unsevered group demonstrated a higher fusion rate at 12 months[Interspinous motion(92.9% vs 74.2%), intra- and extragraft bone bridging(88.1% vs 61.3%)] postoperatively than that of the severed group(P<0.05). The unsevered group demonstrated less incidence of complications than that of the severed group(9.5% vs 32.2%, P<0.05). The JOA scores and neurologic recovery rates at the final follow-up were not significantly different between the two groups(P>0.05). Conclusions: ACAF surgery with unsevered PLL can ensure the decompression effect while reducing the operation difficulty, thus decreasing the operative time, blood loss, and incidence of complications, which can also accelerate postoperative recovery of patients and fusion.