后路单开门颈椎管扩大成形术联合微型钛板固定治疗颈椎后纵韧带骨化症16例

Use of titanium miniplate in cervical expansive open-door laminoplasty for the treatment of Cervical ossification of the posterior longitudinal ligament

目的探讨颈椎后路微型钛板内固定单开门椎管扩大成形术治疗颈椎后纵韧带骨化症﹙OPLL﹚的近期随访疗效。方法选择2009年06月~2011年02月我院行后路单开门椎管扩大椎板成形术并获得完整随访资料的颈椎后纵韧带骨化症患者16例,手术开门减压节段均为C3~C7,＂开门＂侧均使用微型钛板内固定。采用JOA评分评价患者术前、术后神经功能,并计算改善率;对患者术前术后X线、CT及MRI影像学资料进行比较,分析颈椎曲度、椎管矢状径变化及脊髓压迫改善程度,并统计手术并发症。结果所有患者随访6~26个月,平均16.4个月,JOA评分从术前平均8.4±1.1分提高至术后平均13.1±1.5分,平均改善率﹙52.8±16.4﹚%,差异有统计学意义﹙〈0.05﹚;术后颈椎曲度为18.2±5.1°,与术前17.4±4.2°比较无统计学差异;术前椎管矢状径平均为9.2±1.3mm,术后平均为17.4±1.8mm﹙〈0.05﹚,末次随访仍能维持;16例患者术后脊髓压迫较术前均明显改善。手术并发脑脊液漏1例,C5神经根麻痹1例,轴性症状2例。结论颈椎后路微型钛板内固定单开门椎管扩大成形术是治疗颈椎后纵韧带骨化症的一种安全有效的方法。

[Abstract] Objective Exploration of the efficacy of Use of titanium miniplate in cervical expansive open-door laminopla- sty（ open-door ELAP ）for the treatment of Cervical ossification of the posterior longitudinal ligament（ OPLL ）. Methods From Jun 2009 to Feb 2011, a total of 16 cases with Cervical ossification of the posterior longitudinal ligamente OPLL ） underwent open-door ELAP and were followed up in our hospital. All patients had decompression range from C3 to C7, ＂open-door＇side were fixed using titanium miniplate.The preoperative and postoperative neurological status was evalu- ated by JOA scoring system and the improvement rate was also calculated; Yhe preoperative and postoperative imaging examination data including X-rays, CT and MRI were also compared to analyze the change of cervical curvature angle, spinal canal diameter and spinal cord compression degree.Surgical complications were also recorded. Results 16 cases were followed up 6 months to 26 months （ mean,16.4 months ~, the average JOA score was increased from 8.4±1.1 to 13.1± 1.5, with an improvement rate of（ 52.8±16.4 ）%,which showed significant difference（ P〈0.05 ）.There was no sig- nificant difference between preoperative i 7.4±4.2°and postoperative 18.2±5.1 °cervical curvature angle; The preoperative sagitta! diameter of the canal was 9.2±1.3ram which was increased to17.4±1 .Smm after surgery（ P〈0.05 ）, and could main- tain during the follow-up period; Spinal cord compression were markedly improved in all patients.There were 1 patient with dural tear, 1 with C5 nerve root palsy and 2 with the occurrence of axial symptoms. Conclusion Use of titanium mini- plate in cervical open-door ELAP was one of safe and effective surgical method to treat cervical ossification of the pos- terior longitudinal ligament.