前后路联合手术治疗严重颈椎后纵韧带骨化症

Using staged combined anteroposterior operation to treat serious ossification of posterior longitudinal ligament

目的探讨前后路联合手术治疗严重颈椎后纵韧带骨化症（ossification of postprior longitudinal ligament.OPLL）的手术疗效及并发症。方法 2006年1月—2009年1月商丘市中心医院采用前后路联合手术治疗严重颈椎后纵韧带骨化症患者15例,男9例,女6例;年龄3965岁,平均51.6岁。随访时间2436月,平均29.2月。结果 1例患者伤口脂肪液化,经治疗后愈合,1例患者C5神经根麻痹,术后1个月恢复。术前JOA评分（7.8±1.6）分,术后随访时为（14.3±1.3）分,手术前后神经功能评分差异有统计学意义（P〈0.05）。术后恢复了颈椎前凸力线,无前凸角度的丢失。结论颈椎前后路联合手术治疗严重颈椎后纵韧带骨化症疗效良好,有效维持了颈椎曲度,手术并发症少,安全性高,但技术难度大,要求手术医师医术精湛。

Objective To explore the curative effects and the complications of treatment of serious ossification of the posterior longitudinal ligament using staged combined anteroposterior operation.Methods We had treated 15 cases of ossification of the posterior longitudinal ligament patients using staged combined anteroposterior operation from january 2006 to january 2009,there are 9 cases of men,and 6 cases of women,the age of the cases is from 39 to 65,the average age is 51.6.Followed-up 2436 months,the average is 29.2 months.To analyze the videos of x-rays,CT and MRI pre-operation and postoperation,we found the symptoms were improved,and evaluated the treatment effect.Results The patients of this group do not have serious complications,nervous symptom increased,spinal dura damaged,cerebrospinal fluid leak,graft loosened,internal fixation failed and infected and so on.There is 1 case whose cut is fat liquefy,was healed after treatment.1 case whose C5 nerve root paralyzed,was recoverd in a month after operation.The preoperation JOA grade is（7.8±1.6）,the postoperation follow-up grade is（14.3±1.3）,there is statistical significance（P〈0.05） in nervous function grade difference preoperation and postoperation.Vertebrae cervicales lordosis of force line was recovered,there was no loss of the lordosis angle.Conclusions The curative effects is good which use cervical spine staged combined anteroposterior operation to treat serious ossification of the posterior longitudinal ligament,the cervical spine’s degree of curve is effectively maintained,the operation complications are few,the security is high,but the technique difficulty is high,it demands doctor’s exquisite medical skill.