颈椎后纵韧带骨化症术后骨化进展分析

Postoperative progression and its analysis of ossification of the posterior longitudinal ligament on cervical spine

目的 研究颈椎后纵韧带骨化（ossification of posterior longitudinal ligament,OPLL）症术后骨化进展情况.方法 对2001年1月至2007年12月手术治疗的95例颈椎OPLL患者进行回顾性研究,男72例,女23例;年龄40～73岁,平均56.3岁;随访时间1～6年,平均3.1年.颈椎前路手术36例,颈椎后路全椎板减压固定手术57例,前后路联合手术2例.根据术前、术后随访时的X线、CT及MR影像学资料对骨化进展情况进行测量,并通过统计分析性别、年龄、涉及C3OPLL、伴胸椎OPLL、骨化类型、随访时间、手术方式、日本矫形外科学会评分（Japanese orthopaedic association scores,JOA评分）及改善率与骨化术后进展的关系.结果 95例颈椎OPLL术后随访患者中,术后骨化进展39例,男28例,女11例;手术时年龄41～71岁,平均55.9岁;年龄≤49岁12例,50～59岁12例,60～69岁12例,年龄≥70岁3例.颈椎OPLL后路手术后骨化进展有35例,而前路手术后骨化进展仅4例.以骨化物长度和（或）厚度进展≥2mm为标准,单纯骨化长度进展4例;骨化长度、厚度均进展33例;单纯骨化厚度进展2例.骨化长度进展2～20 mm,平均（7.74±4.71）mm;骨化厚度进展2～6 mm,平均（2.67±1.51）mm.在术后1～3年内骨化进展速度呈下降趋势,4～6年骨化则有部分加速趋势.JOA评分及其改善率在术后3年内达到最佳值.统计结果 显示颈椎OPLL术后骨化进展与患者年龄、手术方式以及涉及C3OPLL明显相关.结论 颈椎OPLL术后骨化进展有相当的发生率,涉及C3OPLL、行颈椎后路全椎板切除手术、年轻的颈椎OPLL患者其骨化进展率相对较高.在中短期（1～6年）随访时间内,JOA评分及其改善率受骨化进展影响不大.

Objective To investigate and analyze the postoperative progression of ossification of the patients with ossification of the posterior longitudinal ligament （OPLL） on cervical spine. Methods From Jaunary 2001 to December 2007, 95 postoperative patients with cervical OPLL were followed and analyzed retrospectively. There are 72 males, 23 females, with the average age of 56.3 years （range, 40-73years）. The follow-up time was from 1 to 6 years, average 3.1 years. Among them 36 patients were performed with anterior cervical corpectomy, fusion with titanium mesh and fixed with cervical plates, others treated with posterior cervical laminectomy and fixation. 2 of the 95 cases were performed anterior and posterior combined operation. Clinical data, X-rays, CT and MR images and progression of ossification, were measured and analyzed in details .The relationships between the progression of ossification and relative factors, as gender, age, C3 ossified involved, T-OPLL, OPLL-type, time of follow-up, surgical approach, Japanese Orthopaedic Association （JOA） scores and improvement rate of JOA scores, were analyzed. Results Progression of ossification in 39 cases among the 95 followed postoperative OPLL patients, 28 men and 11 women, average age 55.9 years, range 41-71 years. The age of progressed patients included 12 cases of ≤49 years, 12of 50-59 years, 12 of 60-69 years and 3 of ≥70 years. 35 patients were operated by posterior approach and only 4 treated with anterior operation. According to the standard of the progression of ossification that 2 mm in the length or/and thickness, there are 4 cases progressed only in length, 2 only in thickness, other 33 patients both the length and thickness. Progression of length is from 2mm to 20mm （average 7.74±4.71）. But thickness is progressed from 2 mm to 6 mm （average 2.67±1.51）. From 1 to 3 years follow-up time it appeard as a downtrend about the progression of ossification. But it may appear an uptrend from the 4th year. JOA score and improvement rate of the JOA score were almost improved to the high-point in three years. And according to the statistic data there are obvious relationship between progression of ossification with age, surgical approach and C3 ossified involved. Conclusion There is a high rate of postoperative ossification progression in cervical OPLL patients. Cervical OPLL patients with C3 ossification involved, performed with posterior laminectomy and those young at surgery may have higher rate of progression of the ossification. The JOA score and improvement rate of the JOA score were little influenced by the progression of the OPLL during the short and intermediate-term follow-up.