两种术式治疗颈椎后纵韧带骨化伴发育性椎管狭窄的比较

One-stage anteroposterior surgeries versus posterior surgery only for cervical posterior longitudinal ligament ossification accompanied with developmental spinal stenosis

[目的]比较一期前后路与单纯后路治疗颈椎后纵韧带骨化伴发育性椎管狭窄的临床疗效差异。[方法]回顾性分析本院2013年4月2016年7月收治的颈椎后纵韧带骨化伴发育性椎管狭窄患者31例,根据手术方式不同为分2组,其中前后联合组16例采用一期后路单开门椎管扩大成型术联合前路椎体次全切植骨内固定术治疗,单纯后路组15例采用后路单开门椎管扩大成型术治疗。采用日本矫形外科学会(JOA)颈椎评分系统评估患者神经功能改善情况。行影像检查,测量Pavlov比值、脊髓缓冲空间、K-line阳性率。[结果]31例患者均顺利完成手术。两组患者手术并发症发生率差异无统计学意义(P>0.05)。前后联合组手术时间显著长于单纯后路组(P<0.05);前后联合组术中平均出血量略多于单纯后路组,但差异无统计学意义(P>0.05)。随访(18.48±4.69)个月,两组患者的JOA评分均随时间推移而显著增加(P<0.05)。虽然术前两组间JOA评分的差异无统计学意义(P>0.05),但术后6个月及末次随访时,前后联合组的JOA评分显著高于单纯后路组(P<0.05)。影像方面,两组患者末次随访时各节段(C37)Pavlov比值和脊髓缓冲空间均显著高于术前(P<0.05);但相应时间点两组间各节段(C37)的Pavlov比值的差异均无统计学意义(P>0.05),而末次随访前后联合组患者各节段(C37)脊髓缓冲空间均显著大于单纯后路组(P<0.05)。末次随访时两组患者K-line阳性率均较术前显著增加(P<0.05)。末次随访时前后联合组的K-line阳性率显著高于单纯后路组(P<0.05)。[结论]采用一期前后路手术较单纯后路手术治疗颈椎后纵韧带骨化伴发育性椎管狭窄能够获得更大减压效果,提高临床疗效。

[Objective]To compare the efficacy of one-stage anteroposterior surgeries versus posterior surgery only for cervical ossification of the posterior longitudinal ligament accompanied with developmental cervical stenosis.[Methods]A retrospective analysis was done on 31 patients who were admitted in our hospital for cervical ossification of the posterior longitudinal ligament accompanied with developmental spinal stenosis from April 2013 to July 2016.Of them,16 patients in the AP group underwent one-stage anteroposterior surgeries,while the remaining 15 patients in the P group had only posterior surgery conducted.The Japanese Orthopaedic Association(JOA)scores were used to evaluate the clinical consequences.In addition,the Pavlov ratio,spinal cord reserving space,and K-line positive rate were measured on radiographs,such as X-ray,CT and MRI.[Results]All the 31 patients had operation performed successfully without a statistically significant difference in operative complication rate between the two groups(P>0.05).Although the AP group consumed significantly longer operation time than the P group(P<0.05),there was no a statistically significant difference in intraoperative blood loss between them(P>0.05).The follow-up period lasted for(18.48±4.69)months on average.As time went,the JOA scores in both groups significantly increased(P<0.05).The AP group was marked significantly higher JOA score at 6 months and the latest follow up than the P group(P<0.05),despite of the fact that no a statistically significant difference in JOA score was proved between them before operation(P>0.05).In term of radiographic assessment,the Pavlov ration and spinal cord reserving space at the latest follow up significantly increased compared with those before operation in both groups(P<0.05),regardless of no statistically significant differences in the Pavlov ratio were noted between the two groups at any matching time point(P>0.05).The AP group had significantly greater spinal cord reserving space than the P group at the latest follow up(P<0.05),despite of no a statistically significant difference between them preoperatively(P>0.05).The K-line positive rate significantly increased at the latest follow up in both groups compared with that before operation(P<0.05),and the AP group had significantly higher K-line positive rate than the P group at the latest follow up(P<0.05).[Conclusion]The one-stage anteroposterior surgeries are more safe,reasonable and effective than the posterior surgery only for the treatment of cervical posterior longitudinal ligament ossification accompanied with developmental spinal stenosis.