伴有颈椎曲度不良的颈椎间盘突出合并后纵韧带骨化症患者手术方式比较

Comparison of operation patients in accompanied by cervical vertebra curvature bad disc herniation accompanying ossification of posterior longitudinal ligament

目的对同时存在颈椎曲度不良的颈椎间盘突出合并后纵韧带骨化症的患者分别进行前路及后路手术治疗，通过术后及后期随访，观察不同入路手术对患者预后的影响。方法选择北京军区总医院2011年12月至2012年12月收治的伴有颈椎曲度不良的颈椎间盘突出合并后纵韧带骨化症患者42例，其中，男性29例，女性13例，年龄40～68岁，平均年龄为52.4岁，其中16例患者行前路减压手术，26例患者行后路减压手术，通过术后随访观察两种术式对患者预后的影响。结果患者术后伤口均一期愈合，术后随访6～18个月，平均11.6个月。后路组患者颈椎曲度（10.8±11.2）较前路组（21.6±5.8）相比差异有显著性（P＜0.05），前路组手术后日本骨科学会评估治疗分数（JOA）评分为（14.8±1.8）分，视觉模拟评分法（VAS）评分为（1.22±0.36）分，神经功能恢复率为（76.2±18.4）%；后路组手术后JOA评分为（11.2±2.8）分，与前路组比较差异有显著性（P＜0.05），VAS评分为（1.31±0.62）分，与前路组相比差异无显著性（P＞0.05），神经功能恢复率为（48.6±26.4）%，与前路组相比差异无显著性（P＞0.05）。结论对于伴有颈椎曲度不良的颈椎间盘突出合并后纵韧带骨化症患者行前路手术相对安全，并且对于患者颈椎曲度的恢复、神经功能的改善以及影像学评价均优于后路手术。

Background Anterior and posterior approach operation of cervical vertebra curvature evaluation with bad disc herniation in patients with ossiifcation of the treatment effect is clear, whether the operation scheme of choice remains controversial. Objective To exist at the same time cervical cervical curvature bad disc herniation accompanying OPLL patients were treated by anterior and posterior operation, postoperative and follow-up, to observe the effect of different approaches on the prognosis of patients after operation. Methods Selection of General Hospital of Beijing Military Region from 2011 December to 2012 December cervical vertebra were treated with cervical curvature bad disc herniation in patients with ossiifcation in 42 cases, among them, male 29 cases, female 13 cases, age 40~68 years old, with an average of 52.4 years, of which 16 cases were treated by anterior decompression operation, 26 patients who underwent posterior decompression operation, through follow-up observation of effects of two kinds of operation on the prognosis of the patients. Results The wound healed after surgery, patients were followed up for 6~18 months, average 11.6 months. The posterior group of cervical curvature (10.8±11.2), (21.6±5.8) had signiifcant difference (P < 0.05), treatment score assessment of Japan Association for Department of orthopedics anterior group after operation (JOA) score was (14.8±1.8), visual analogue scale (VAS) score was (1.22±0.36), neurological function recovery rate was (76.2±18.4)%;the posterior group after operation JOA score was (11.2±2.8)%, there was signiifcant difference compared with the anterior group (P < 0.05), VAS score (1.31%±0.62%), compared with the anterior group had no signiifcant difference (P>0.05), neurological function recovery rate was (48.6±26.4)%compared with the anterior group had no signiifcant difference (P>0.05). Conclusion The cervical vertebra with cervical curvature bad disc herniation after operation in patients with ossiifcation of the anterior longitudinal ligament is relatively safe, and recovery of neural function for the patients with cervical curvature, and the improvement of imaging evaluation are better than the posterior operation.