颈椎后纵韧带骨化症的手术治疗

Surgical Treatment of Ossification of Posterior Longitudinal Ligament of Cervical Spine

目的探讨颈椎后纵韧带骨化症手术治疗方法及其疗效。方法回顾性分析2002年1月至2008年1月我院65例颈椎后纵韧带骨化症手术治疗病例,均有程度不等的脊髓压迫症状。41例合并发育性颈椎管狭窄,平均椎管狭窄率42.1%。术前均行X线、CT平扫加矢状位重建和MRI检查。其中23例行前路手术,37例行后路手术,5例行前后路联合手术。结果65例获6～72个月随访,平均随访时间19个月。根据日本矫形外科学会评分标准,颈前路手术平均改善率70%,颈后路手术平均改善率66.3%,颈前后路联合手术平均改善率75.4%。术后并发节段性神经根麻痹5例。结论根据患者病情和影像学表现,尤其是CT矢状位重建,仔细分析后纵韧带骨化部位、范围及椎管狭窄率,选择合适手术方法,方能减少并发症,提高手术疗效。

Objective To discuss surgical approaches and results of ossification of posterior longitudinal ligament （OPLL）of cervical spine. Methods This study examined retrospectively the 63 patients with ossification of posterior longitudinal ligament of cervical spine from January 2002 to January 2008 ,which were treated operatively. All patients had different compression symptom of spinal cord. 41 patients had cervical stenosis,the mean occupancy rate was 42. 1%. Cervical X-ray,CT, 2D-CT and MRI was evaluated before operation routinely. Of 65 patients, 23 were decompressed from an anterior approach, 37 from a posterior approach and 5 from anteroposterior approach. Results 65 cases were followed up for 6-72 months ,The average followed up period was nineteen months. According to criteria of Japan Orthopedic Association（JOA）,the mean postoperative improvement rate was 70 % in patients treated by anterior decompression, 66.3% in those treated by posterior decompression and 75.4% in those treated by anteroposteriot decompression. There were 5 patients with segmental nerve root palsy. Conclusion Suitable operation methods should be chosen according to patients＇clinic symptom and radiology evaluation,especially 2D-CT to evaluate the location,extent and occupancy ratio of OPLL. It is important for avoiding complications and improving surgical results.