单节段颈椎后纵韧带骨化症前后路手术的疗效比较

Comparison of therapeutic effects between anterior and posterior decompression on single-segment cervical ossification of posterior longitudinal ligament

目的比较前路与后路手术治疗颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)的疗效。方法回顾2006年1月～2010年12月,收治的24例单节段颈椎OPLL患者,根据手术入路分为2组,前路手术(A组)10例,行前路骨化节段椎体次全切除、骨化的后纵韧带切除,前路植骨融合内固定;后路手术(B组)14例,行后路减压,以骨化节段椎板为中心,切除3节段全椎板,后路植骨融合,内固定。比较2组患者术前、术后1周、3个月、12个月和24个月的日本骨科学会(Japanese Orthopaedic Association,JOA)评分以及并发症情况。结果所有患者JOA评分均有不同程度的改善,较术前的差异有统计学意义(P<0.05)。但2组患者术后JOA评分差异无统计学意义(P<0.05)。A组术后并发脑脊液漏及脊髓功能下降各1例;B组术后并发C5神经综合征及切口脂肪液化各1例。结论单节段颈椎OPLL前路手术与后路手术的近中期疗效无明显差异。后路手术风险相对较小,前路手术难度较大,并发症较严重。

Objective To compare the therapeutic effects between anterior and posterior decompression on single-segment cervi- cal ossification of posterior longitudinal ligament （OPEL）. Methods A total of 24 cases of single-segment cervical OPLL treated from January 2006 to December 2010 were retrospective analyzed. The cases were divided into 2 groups according to surgical approach. In the anterior approach group （ Group A）, all of 10 cases were operated for fusion and fixation by anterior approach, ossification segment vertebral and posterior longitudinal ligament were excised. In the posterior approach group（Group B）, all of 14 cases underwent posterior decompression, fusion and fixation, and 3 segment of ossification lamina of vertebra were excised. The Japanese Orthopaedic Association（JOA） scores of pre-operation, postoperative I week, 3 months, 12 months and 24 months and complications of 2 groups were analyzed. Results JOA scores of all patients improved and the differences were statistically signifi- cant compared with pre-operation（P 〈0. 05）. The differences of postoperative JOA scores between 2 groups were not statistically significant（P 〉0.05）. In Group A, cerebrospinal leak occurd in 1 case and spinal cord function decent in 1 case. In Group B C5 neurologic syndrome occurd in I case and fat liquefaction of incision in one case. Conclusion There is no significant difference in the recent mid-term efficacy in anterior or posterior decompression of single segment of cervical posterior longitudinal ligament ossifi- cation. The risk of posterior surgical is relatively small, there is more difficult, more serious complications of anterior surgery.