脊髓型颈椎后纵韧带骨化症的手术治疗

Surgical treatment of ossification of the posterior longitudinal ligament of cervical spine

[目的]比较分析不同手术入路治疗脊髓型颈椎后纵韧带骨化症的疗效及并发症。[方法]回顾性分析本院自2005年1月～2009年3月56例脊髓型颈椎后纵韧带骨化症患者的手术入路、手术方式、手术时间、出血量、手术疗效及其并发症。[结果]56例患者随访20个月～6年,平均3.8年;前路手术25例,手术时间为(220.00±35.82)min,术中出血量为(280.00±127.48)ml,术前JOA评分8.36±1.41,术后JOA评分13.52±2.00,改善率为61.92%±16.46%,并发症发生7例;后路手术21例,手术时间为(118.57±22.20)min,术中出血量为(414.29±200.71)ml,术前JOA评分8.23±1.67,术后JOA评分13.19±1.97,改善率为58.57%±15.36%,并发症发生5例;前后联合手术10例,手术时间为(309.00±51.09)min,术中出血量为(760.00±337.30)ml,术前JOA评分7.40±1.07,术后JOA评分13.70±1.64,改善率为66.60%±13.29%,并发症发生3例;三组病例术中出血量、手术时间行组间比较有显著性差异(P<0.05),但三组术前JOA评分、术后JOA评分、术后改善率、手术并发症发生例数行组间比较无显著性差异(P>0.05)。[结论]脊髓型颈椎后纵韧带骨化症前、后路或前后联合入路手术疗效均良好,手术并发症发生率均比较高,因此脊髓型颈椎后纵韧带骨化症的手术入路选择,除了要全面考虑患者病情,同时必须兼顾自身技术特点及条件,只要能够安全地对脊髓进行充分减压,维持或重建颈椎的稳定性,三种治疗方案均是可以选择的治疗手段,但前后联合入路手术时间长、出血量大,宜慎重。

[Objective]To compare the clinical outcomes and complications of different approaches for ossification of the posterior longitudinal ligament（OPLL） of cervical spine. [Methods]From January 2005 to March 2009,the clinical data of 56 patients with cervical OPLL were reviewed and analyzed.The operative approach,operative methods,operative time,blood loss,complications were recorded. [Results]All patients were followed up for 20 months to 6 years（mean,3.8 years）.Twenty-five patients were decompressed through anterior approach.In these patients,the operative time was 220.00±35.82 minutes,the operative blood loss was 280.00±127.48 ml,JOA（Japanese Orthopedics Association） score before operation was 8.36±1.41,JOA score after operation was 13.52±2.00,and the improvement rate was 61.92%±16.46%.Seven patients developed complications.Twenty-one patients were decompressed through posterior approach.In these patients,the operative time was（118.57±22.20） minutes,the operative blood loss was（414.29±200.71） ml,JOA score before operation was 8.23±1.67,JOA score after operation was 13.70±1.64,and the improvement rate was 58.57%±15.36%.Five patients developed complications.Ten patients were decompressed through combined posterior-anterior approach.In these patients,the operative time was（309.00±51.09） minutes,the operative blood loss was（760.00±337.30） ml,JOA score before operation was 7.40±1.07,JOA score after operation was 13.70±1.64,and the improvement rate was 66.60%±13.29%.Three patients developed complications.Among the three groups,the operative blood loss and the operative time showed significant difference（P0.05）,the JOA score before operation,the JOA score after operation,the improvement rate and the complications showed no difference（P0.05）. [Conclusion]The clinical outcome of cervical OPLL treated through anterior approach,posterior approach and combined posterior-anterior approach is satisfactory.But the incidence of complications is high.When we select the operative approach for cervical OPLL,we should consider not only the pathogenetic condition of patients,but also our own technology.Each of the three operative approaches can be used.But it should be prudent when we select combined posterior-anterior approach for cervical OPLL.