颈椎后纵韧带骨化症患者K线对两种颈后路手术疗效的影响

The influence of K-line on two posterior approaches for patient with ossification of posterior longitudinal ligament

目的:评价颈椎后纵韧带骨化症(OPLL)患者的K线对颈后路单开门椎管扩大成形术(laminoplasty,Lam)和颈后路椎板切除减压融合内固定术(laminectomy and instrumentation,LI)疗效的影响。方法:回顾性分析2003年1月-2011年2月在我院接受手术治疗的78例OPLL患者,其中Lam治疗32例,LI治疗46例。将颈椎侧位片上C2和C7椎管中点连线未跨越骨化物的病例定为K(+),54例[K(+)组];跨越骨化物者定为K(-),24例[K(-)组]。记录患者术前及末次随访时的JOA评分及术后轴性痛、C5神经根麻痹发生的情况,分析K线对术后神经功能恢复和相关并发症的影响。结果:K(+)组患者术后神经功能改善率平均为68.2%,K(-)组患者为38.8%,两组间有统计学差异(P<0.01)。K(+)组患者中接受Lam术式者神经功能改善率为69.9%,接受LI术式者为65.6%,无统计学差异(P>0.05);K(-)组患者中接受LI术式者平均神经根功能改善率为47.0%,接受Lam术式者为33.9%,两组间有统计学差异(P<0.05)。两组接受LI术式者轴性痛出现时间均明显早于接受Lam者(P<0.05),术后C5神经根麻痹发生率明显高于接受Lam者(P<0.01)。结论:术前K(+)的病例术后神经功能恢复优于K(-)病例;对于K(+)患者,两种术式疗效相当;对于K(-)患者,接受LI术后神经功能改善率优于接受Lam者。接受LI者术后轴性痛发生较早、C5神经根麻痹发生率较高。

Objectives： To elevate the influence of K-line on the outcome of laminoplasty（Lam） vs laminec- tomy and instrumentation（LI） for patient with ossification of posterior longitudinal ligament（OPLL）. Methods： 78 patients undergoing Lam（32） and LI（46） from January 2003 to February 2011 were included in this series. 54 cases with the ossification mass not beyond the line at the midpoint of spinal canal from C2 to C7 were grouped as K（＋）, while 24 cases with ossification mass exceeding the K-line were grouped as K（-）. The pre- operative and follow-up JOA scores, and postoperative complications were recorded to analyze the influence of two approaches on the outcome. Results： The improvement rate of neurologic function（IR） after posterior ap- proaches in cases of group K（＋） and K（-） was 68.2% and 38.8% respectively, which showed significant differ- ence （P〈O.O1）. In group K（＋）, the IR of cases for Lam was 69.9%, and 65.6% for LI, which showed no sig- nificant difference （P〉O.05）. In group K（-）, the IR for LI was 47.0%s and 33.9% for Lam, which showed sig- nificant difference（P〈O.05）. The onset was significantly earlier and the incidence of C5 palsy was significantly higher in cases with LI than cases with Lam（P〈0.05）. Conclusions： Preoperative K（＋） predicates a better IR than K（-）. For cases with K（-）, LI provide better neurologic function recovery. LI indicate higher incidences of C5 palsy and the earlier onset of axial pain.