混合型颈椎后纵韧带骨化症的手术治疗

Surgery treatment to the mixed ossification of posterior longitudinal ligament

[目的]探讨混合型颈椎后纵韧带骨化症手术治疗的疗效及影响预后的相关因素分析。[方法]自2003年6月～2007年6月共收治混合型颈椎后纵韧带骨化症患者42例,其中18例行颈后路单开门椎管成型锚钉内固定,15例行后路单开门椎管成型丝线固定术、9例行单纯后路椎板切除椎管减压术,对手术前后JOA评分、颈肩痛及预后的影响因素进行随访观察。[结果]随访6个月～4年(平均23个月),42例患者均获随访,锚钉内固定组、丝线固定组、单纯减压组术前术后各组手术前后评分之间存在显著性差异(t检验,P<0.05)。术后颈肩部疼痛评分锚钉内固定组优于其他两手术组(q检验,P<0.05)。颈椎节段最大活动度、活动节段最小残留率、脊髓膨胀率与JOA评分改善率之间存在线性相关。[结论]后路椎板成型和椎板减压是治疗混合型OPLL的有效方案;颈椎节段最大活动度、活动节段最小残留率、脊髓膨胀率与JOA评分改善率之间存在相关性;锚钉内固定对术后颈肩痛的预防有一定作用。

[ Objective] To analyze the effect of the surgical operation for cervical myelopathy due to mixed ossification of posterior longitudinal ligament （OPLL） . [ Methods] Forty -two patients with mixed OPLL were enrolled from June 2003 to June 2007. Eighteen were treated with posterior laminoplasty combined with anchor nail fixation （ group A） . Fifteen with laminoplasty （ group B） and the other nine with lamineetomy （ group C ） . According to the Japanese Orthopaedic Association （JOA） scoring system for cervical myelopathy, the neural function scores were obtained. The cervical shoulder pain score and the influence factors for prognosis were documented. [ Results ] All patients were followed for 6 months to 4 years （ mean 23 months） . The differences between preoperation and post operation were significant among the three different surgery type groups （P 〈 0. 05 ） . The post surgical cervical shoulder pain score in group of the anchor nail fixation was better than those in the other two groups （ P 〈 0. 05 ） . [ Conclusion ] Posterior laminoplasty and laminectomy are effective to patients with mixed OPLL. There is a linear correlation between JOA score, the maximum motion of cervical segment, the minimum residual rate of the motioning segment and spinal cord swelling . The anchor nail fixation could prevent the cervical and shoulder pain to some degrees.