颈椎后纵韧带骨化手术疗效分析

Therapeutic Effect Analysis on Cervical Ossification in Posterior Longitudinal Ligament by Different Approaches

目的观察颈椎后纵韧带骨化症(ossification of the posterior longitudinal ligament,OPLL)的手术治疗效果,分析影响疗效的因素。方法随访2003年2月至2006年2月在首都医科大学附属北京天坛医院骨科经手术治疗的OPLL患者25例,其中经颈前入路手术者16例,颈后路手术者6例,前、后联合入路手术者3例。术前及术后1～2年分别应用JOA17评分法及影像学评估法进行评估,分析比较术前与术后JOA评分并计算改善率。结果在前路手术治疗的OPLL患者中,有2例术后出现神经症状一过性加重,分别于术后4周和12周内恢复。25例患者术前评分平均为(8.00±1.50)分(最低5分,最高11分),术后2年评分平均为(14.24±1.42)分(最低9分,最高16分),平均提高6.24分。神经功能平均改善率为69.80%±12.28%,手术前、后评分比较差异有统计学意义,手术效果明显。术后复查MRI影像学资料显示,本组患者脊髓和神经根减压充分,前路植骨平均术后3个月骨性愈合。结论OPLL经颈前路手术可直接切除致压物,减压彻底,钛板固定可靠,手术效果良好,但手术风险及合并症高于后路手术。联合入路可降低手术风险。应用显微外科技术及手术全程神经电生理监测对提高手术的安全性有重要意义。

Objective To observe and analyze the clinical results of treating ossification in posterior longitudinal ligament（OPLL） by surgery. Methods Follow-up investigation of 25 patients who received surgery for OPLL between Feb, 2003 and Feb, 2006. Sixteen patients with OPLL in less than three segments were given anterior cervical decompression ; Six patients with more than three segments were given posterior surgery; three patients were given anterior-posterior surgery. The pre ＆ post-operative scores of JOA 17, cervical images and the improvement ration were evaluated. Results Two patients＇ conditions worsened in neural symptoms after the anterior surgery, but recuperated in 4 and 12 weeks. Leakage of cerebrospinal fluid occurred with one patient during anterior surgery. According to JOA 17 Score, the preoperative mean score was 8.00 ± 1.50 （ min： 5, max ： 11 ）, while the postoperative mean score was 14.24 ± 1.42 （min： 9, max： 16）. The ratio of improvement was （69.80 ± 12.28）%. MRI studies indicated that spinal cord and nerve roots were decompressed thoroughly, and all bone graft got synostosis with in 3 months postoperatively. Conclusion The anterior operation has a significant effect on OPLL, which could resect the ossific tissue directly, decompress the spinal cord completely, and fix the vertebrae firmly. However, the dangers and complications of anterior operation are higher than those of a posterior one. Anterior-posterior-union surgery may alleviate the dangers, and microsurgery and supervision by SEP during operation have an important effect on the safety of surgery.