全椎板减压侧块螺钉内固定治疗颈椎后纵韧带骨化症的疗效分析

Posterior laminectomy and lateral mass screw fixation for cervical ossification of posterior longitudinal ligament

目的:探讨后路全椎板减压侧块螺钉内固定治疗颈椎后纵韧带骨化症的疗效。方法:32例颈椎后纵韧带骨化症患者,平均年龄57.5岁,分别行后路单开门椎管扩大椎板成形术(A组,17例)和全椎板减压侧块螺钉内固定术(B组,15例)治疗。随访观察并比较两组患者手术时间、术中出血量、术后神经功能恢复情况及手术并发症的发生情况,并对两组患者术后颈椎的生理曲度及颈项肩背部疼痛、僵硬等轴性症状进行评估。结果:A组患者术后均无椎板开门再闭发生,B组患者术后植骨均完全融合,无内固定脱出、断裂等并发症发生。随访12个月,JOA评分显示,A组由术前的7.06±0.92分提高到末次随访时的13.62±1.22分,B组由术前的7.23±1.10分提高到末次随访时的13.73±0.98分,两组术前、末次随访时相比均无统计学差异(P>0.05);两组改善率的差异也无统计学意义(P>0.05)。颈椎曲度A组、B组术前分别为3.81±1.14mm和3.67±1.28mm,末次随访时为3.62±1.08mm和7.26±1.52mm,B组末次随访时较术前有明显增加(P<0.01),与A组相比末次随访时差异有统计学意义(P<0.01)。末次随访时颈部轴性症状A组发生率为65.71%,B组为26.67%,两组相比差异有统计学意义(P<0.05);颈项肩背部疼痛程度的VAS评分A组为5.64±3.19分,B组为2.92±3.00分,两组相比差异有统计学意义(P<0.05)。结论:颈后路全椎板减压侧块螺钉内固定治疗颈椎后纵韧带骨化症,能取得同单纯颈后路单开门椎管扩大椎板成形术相似的疗效,并能恢复颈椎生理曲度,提供坚强的内固定,防止术后颈椎不稳,降低术后轴性症状的发生,短期随访效果满意。

Objective：To evaluate the effect of posterior laminectomy and lateral mass screw fixation for cer- vical ossification of posterior longitudinal ligament （OPLL）.Method：From January 2007 to January 2009,32 patients with cervical ossification of posterior longitudinal ligament,aged 41-75 years old （average,57.5 years old）,underwent posterior approach.Patients were divided into two groups based on surgical protocols,17 pa- tients underwent open-door laminoplasty （group A） and 15 patients underwent laminectomy and lateral mass screw fixation （group B）.All patients were followed up for at least 12 months.In both groups,the operation time,intraoperative blood loss,the neurologic improvement,rate of complications,cervical curvature and inci- dence of neck axial symptoms were recorded and com＇pared.Result：No lamina reclose was noted in group A after open-door laminectomy.Group B showed no instrument failure,but perfect bony union.Group A had JOA score improved from 7.06-＋0.92 preoperatively to 13.62-＋1.22 postoperatively,with postoperative improvement rate of 66.69%＋0.09% for group A and 67.04%_＋0.07% for group B,which showed no significant difference between two groups（P〉0.O5）.The cervical curvature was 3.81＋_1.14mm in group A and 3.67＋1.28mm in group B preoperatively,3.62±1.08mm in group A and 7.26±1.52mm in group B postoperatively,which showed signifi- cant difference in group B （P〈0.05） as well as between two groups （P〈O.O5）.The rate of postoperative neck axial symptom noted was 65.71% in group A and 26.67% in group B,which showed statistical significance （P〈0.O5）.Condusion：Posterior laminectomy and lateral mass screw fixation for cervical ossification of posterior longitudinal ligament provide equal effect as open-door laminoplasty.The short-term outcome is satisfactory due to good biomechanical stability provided and decreasing of postoperative axial symptoms.