不同椎间植入物内固定方式治疗长节段颈椎后纵韧带骨化症的比较

Different interbody implants for long segment ossification of cervical posterior longitudinal ligament

背景：颈椎长节段后纵韧带骨化症的治疗方法目前各界尚存争议,无指导性的标准方案。目的：对比分析不同路径椎间植入物内固定治疗长节段颈椎后纵韧带骨化症的效果。方法：随访35例长节段颈椎后纵韧带骨化症伴重度脊髓型颈椎病患者,前路内固定组10例患者采用颈前路椎体次全切、骨化灶切除或部分切除、椎间植骨融合内固定;后路内固定组16例患者采用颈后路单开门减压椎管成形、椎体侧块内固定;后路无内固定组9例患者采用后路单开门减压椎管成形。结果与结论：患者均获随访,随访时间为6~24个月。治疗后12个月JOA评分改善率前路内固定组、后路内固定组、后路无内固定组分别为79.59%,83.01%及60.35%。治疗后前路内固定组1例患者并发脑脊液漏;后路无内固定组3例患者治疗后症状改善不明显;后路内固定组治疗效果好,无并发症。表明后路椎管成形经椎弓根钉内固定治疗长节段颈椎后纵韧带骨化症具有减压完全、安全有效、长期效果佳的特点,是治疗该病的一种较好方法。

BACKGROUND：Treatments for ossification of cervical posterior longitudinal ligament（OPLL） are controversial,and there is no there is no standard treatment program.OBJECTIVE：To discuss and analyze the different surgical treatments effect on long-segment OPLL.METHODS：Thirty-five long-segment OPLL accompanied with severe cervical spondylotic myelopathy were followed up,including 10 cases undergoing anterior cervical corpectomy,removal or partial removal of ossification foci,interbody implant fusion as group A,16 receiving posterior open-door laminoplasty,decompression,bone graft and internal fixation as group B,and 9 undergoing posterior open-door laminoplasty without internal fixation as group C.RESULTS AND CONCLUSION：All cases were followed up for 6-24 months.Twelve months after treatment,the mean amelioration rate was 79.59% in group A,83.01% in group B,60.35% in group C.There was 1 case with dural tear in group A,and 3 cases without obvious symptom changes in group C.These findings indicate that the therapy of open-door laminoplasty,decompression,bone graft and internal fixation is good,safe and effective for long-segment OPLL.