后路手术治疗颈椎后纵韧带骨化症的疗效分析

Analysis of curative effect of posterior surgical procedures in the treatment of cervical ossification of posterior longitudinal ligament

目的分析后路椎板切除融合固定术治疗颈椎后纵韧带骨化症（ossification of posterior longitudinal ligament，OPLL）的疗效及并发症，并探讨二者的影响因素。方法2003年4月-2009年12月，采用后路椎板切除融合固定术治疗颈椎OPLL患者54例。采用日本骨科学会（Japanese Orthopedic Associmion，JOA）神经功能评分评价患者术前、术后神经功能，将患者分为疗效良好和疗效不佳2个组。分析患者年龄、性别、症状持续时间、术前JOA评分、是否合并糖尿病、颈椎曲度、椎管狭窄率、骨化物范围、骨化物分型、是否有脊髓高信号对患者手术疗效及并发症的影响。结果随访1—6年，平均3．3年。患者神经功能JOA评分从术前9．2±1．3分增加至术后14．2±0．9分，差异有统计学意义（P〈0．01），神经功能改善率（improvement rate，IR）为（62．4±13．2）％。其中35例患者手术疗效良好（IR≥50％），19例患者疗效不佳（IR〈50％）。术后并发症包括9例神经根麻痹和2例血肿压迫。影像学研究表明手术疗效良好患者术后颈椎曲度明显大于手术疗效不佳患者，差异有统计学意义（P〈0。01），术后神经根麻痹患者的颈椎曲度矫正程度明显大于非麻痹患者，差异有统计学意义（P〈0．05）。结论后路椎板切除融合固定术是一种适于治疗严重的多节段颈椎OPLL的手术方式，术中矫正患者颈椎曲度有利于提高手术疗效，但同时可能增加术后神经根麻痹的发生率。

Objective To analyze the curative effect and complications of posterior surgical procedures in the treatment of cervical ossification of posterior longitudinal ligament （OPLL）, and discuss the influencing factor of them. Methods From April 2003 to December 2009, a total of 54 patients underwent posterior laminectomy and instrumented fusion for the treatment of cervical OPLL. Japanese Orthopedic Association （JOA） scoring system was used for evaluating patients＇ neurological status, by which the patients were devided into 2 groups： good-prognosis group and peor-prognosis group. Age, sex, duration of symptoms, preoperative JOA score, with diabetes mellitus or not, cervical lordosis, stenotic ratio of spinal canal, extent of OPLL, type of OPLL and hyper- intense areas on MRI or not were analyzed by muhifactorial analysis with the curative effect arid complications. Results After an average 3.3-year follow-up （range 1 to 6 years）, the JOA score significantly increased from 9.2 ± 1.3 preoperative to 14.2 ±0.9 postoperative, and the difference was statistically significant （P 〈 0. 01 ）, with a mean improvement rate （IR） of （62.4 ± 13.2）%. Among the patients, 35 （64. 8% ） cases had good prognosis （IR ≥50% ）, and 19 （35.2%） cases had poor prognosis （IR 〈 50% ）. The complications included nerve root palsy in 9 cases and hematoma in 2 cases. Radiological studies showed postoperative cervical lordosis of the patients with good prognosis was significantly larger than that of the patients with poor prognosis, and the difference was statistically significant （P 〈0. 01 ） ; the increase of cervical lordosis in the patients with nerve root palsy was significantly larger than that in the patients without palsy, and the difference was statistically significant （P 〈0.01 ）. Conclusion Posterior laminectomy and instrumented fusion is a suitable surgical option for severe multisegment OPLL. Improving cervical lordosis intraoperatively could provide better decompression effect and good prognosis, but simultaneously hkely contributed to the high incidence of postoperative nerve root palsy.