颈椎后纵韧带骨化症及其外科治疗(附76例报告)

Cervical ossification of posterior longitudinal ligament and its surgical therapy:a report of 76 cases

目的：研究不同手术方式对颈椎后纵韧带骨化症（ＯＰＬＬ）的治疗效果和远期影响。方法：本组７６例患者均行手术治疗，其中颈前路减压＋植骨融合术１８例，颈后路半椎板减压４３例，全椎板减压４例，椎管成形术１１例（单开门５例，双开门６例）。结果：手术减压治疗效果的优良率为７９．７％，但不同术式对远期效果的影响不同。部分患者出现术后颈椎失稳，其中全椎板减压术的发生率为５０％，半椎板减压术为２２．２％，颈前路减压＋植骨融合术为１３．３％。椎板减压术患者中５例后期出现骨化灶进一步发展。结论：多数情况下椎管狭窄率与临床表现的程度成正比，大于４０％应考虑手术治疗；全椎板切除减压术对颈椎稳定性影响较大，而施行椎管成形术则能较好地保留颈椎的稳定性；施行椎管成形术和颈前路减压＋植骨融合术未见骨化灶进一步发展，其原因之一可能是改变了椎管内的力学环境。

Objective: To study the results and the longterm effects of surgical therapy of cervical ossification of posterior longitudinal ligament (OPLL) from different operation methods. Methods: Seventy six cases were operated on. Among them, 18 cases were decompressed from anterior approach with bone fusion, 43 were decompressed by semilaminectomy and 4 total laminectomy, 11 were operated on by laminoplasty ( 5 in singleopendoor technique, 6 in dualopendoor style ). Results: The ratio in excellent and good results was 79.9%. Longterm effects were different with different operation styles. The instability rate of cervical spine occurred in 50% cases decompressed by total laminectomy, 22.2% by semilaminectomy and 13.3% by anterior decompression with bone fusion. Ossification development in 5 cases (7.8%) was seen in laminectomy groups. Conclusion: In most cases, the stenosis rate is directly related to the severity of clinical features, and surgical therapy should be considered if the rate is over 40%. The operation style should be chosen based on the pathology of OPLL. The instability rate of cervical spine after total laminectomy was highest, whereas good stability was noted in those with laminoplasty. No ossification development can be seen after laminoplasty, and one of the possible reasons is that the mechanical environment inside cervical channel has been changed.