后前路联合分期手术治疗颈椎后纵韧带骨化症伴发育性椎管狭窄

Combined stages of anteroposterior operation for ossification of cervical posterior longitudinal ligament associated with developmental spinal stenosis

[目的]探讨颈椎后纵韧带骨化症伴发育性椎管狭窄的临床特点及后前路分期手术治疗此症的手术疗效。[方法]回顾性研究自1999年6月以来采用后前路分期手术治疗颈椎后纵韧带骨化症伴发育性椎管狭窄患者39例,男28例,女11例;年龄37~61岁,平均49.7岁。病程5个月~8年,平均19个月。其中23例有外伤史。采用日本矫形外科协会（JOA）17分评分法颈髓症判定标准对患者术前、随访时的神经功能状态进行评估;以D值评价颈椎的前凸或后凸情况,并对手术前后数据分别行配对t检验分析。[结果]本组患者均无神经症状加重及感染等严重并发症发生。2例患者发生一过性C5神经根麻痹,于术后1个月恢复;2例患者伤口脂肪液化,经治疗后愈合。随访时间18~36个月,平均22.3个月。随访期间未发生植骨块松动及内固定失败等现象。术前JOA评分（8.26±1.32）分,术后随访时（12.34±1.21）分,手术前后神经功能评分差异有显著性意义（P〈0.01）;术前D值（3.26±0.15）mm,随访时为（7.34±0.21）mm,手术前后D值比较差异有统计学意义（P〈0.01）。[结论]后前路分期手术治疗颈椎后纵韧带骨化症伴发育性椎管狭窄取得了良好的临床疗效,颈椎曲度得到有效维持,手术并发症少,安全性高。

[Objective]To discuss the clinical features of ossification of cervical posterior longitudinal ligament with developmental spinal stenosis and evaluate the outcomes of combined stages of anteroposterior operation. [Methods]Thirty-nine patients admitted to our hospital from June 1999 to June 2006 underwent combined stages of anteroposterior operation.There were 28 males and 11 females,aging from 37~61 years（with the mean age of 49.7 years）,with the disease-process of 5 months-10 years（average 19 months）.Neurological outcome was judged by JOA grading system before and after surgery.Lordosis（kyphosis） of cervical spine was evaluated by D numerical value.[Results]There were no severe complications.Two cases of transient C5 nerve paralysis were recovered one month after surgery and two patients of fat necrosis healed satisfactorily.The average period of follow-up were 22.3 months.The preoperative JOA score was 8.26±1.32 points.The postoperative score were 12.34±1.21 points.There was significant difference between before and after surgery in JOA score and D numerical value.[Conclusion]The use of combined stages of anteroposterior operation for ossification of cervical posterior longitudinal ligament with developmental spinal stenosis can offer an excellent clinical result and have fewer complications.