颈椎后纵韧带骨化症的手术治疗及前后路手术比较

Surgical Treatment of Cervical Ossification of the Posterior Longitudinal Ligament and Comparison between Anterior and Posterior Approach

目的总结分析手术治疗颈椎后纵韧带骨化症(ossification of the posterior longitudinal ligament,OPLL)的结果,比较颈前路与颈后路手术治疗OPLL的优缺点。方法从2009年1月到2011年7月手术治疗颈椎OPLL患者22例,其中10例采用颈前路椎体次全切除+骨化灶切除+植骨钢板内固定术,12例采用颈后路全椎板切除减压术。比较前路与后路术前的基本因素(年龄、性别、随访时间、病程、骨化灶累计节段数、椎管狭窄率、术前日本骨科协会(Japanese orthopaedic association,JOA)评分)、手术时间、出血量、并发症及两组术后JOA评分、JOA评分改善率、手术优良率之间的差别。结果所有患者均获随访,平均随访时间22.5个月,最短9个月,最长38个月。a)手术前后JOA评分有显著性提高(P值小于0.001),总计平均增加4.77分,前路组平均增加4.80分,后路组平均增加4.75分。b)JOA平均改善率为72.25%,前路平均改善率为73.26%,后路为71.40%。c)手术优良率为77.3%。前路优良率为80%,后路优良率为75%。d)颈前路、颈后路手术时间出血量差异无统计学意义。e)前路与后路两组术前的基本因素(年龄、性别、随访时间、病程、骨化灶累计节段数、椎管狭窄率、术前JOA评分)差异无统计学意义,比较两组术后JOA评分、JOA评分改善率及手术优良率,两组间差异亦无统计学意义,但是前路手术更容易发生脑脊液漏的并发症(2/10),而后路无一例发生。结论对于颈椎OPLL患者,行颈前路椎体次全切除+骨化灶切除+植骨钢板内固定术或颈后路全椎板切除减压术的手术短期疗效是满意的。前路与后路手术疗效无明显差异,手术入路的选择应取决于不同患者的特点和外科医生的经验。

Objective To evaluate and analyze the clinical results of patients with ossification of cervical posterior longi- tudinal ligaments（OPLL） treated surgically, and compare the two surgical methods of cervical anterior and posterior decom- pression for cervical OPLL. Methods 22 eases of cervical OPLL were performed by cervical anterior corpeetomy with fusion and internal fixation （10 eases） and posterior lamineetomy （12 cases ） from January 2009 to July 2011. The following factors were compared between anterior group and posterior group：operation time, bleeding amount, eomplications, postoperative JOA scores, the recovery rate of JOA scores, the excellent rate of operation and the preoperative pacing factors （ age at operation, gender, following - up period, duration of symptoms, occupying ratio, levels of OPLL, preoperative JOA scores）. Results The average follow - up period was 22.5 months, ranging from 9 and 38 months, a）The postoperative JOA scores were statistically greater than preoperative JOA scores （ P 〈 0.0 0 1 ） . All the 2 2 patients ＂JOA scores increased 4. 7 7 averagely, anterior group 4.80, posterior group 4.75, respectively, b）The mean reeovery rate of JOA scores was 72.25% , anterior group 73.26% , poste- rior group 71.40% , respectively, c）The mean excellent rate of operation was 77.3% , anterior group 80%, posterior group 75 % , respectively, d）The operation time and bleeding amount between the two groups had no statistical differences, e）The an- terior group and posterior group had no statistical differences in age at operation, gender, following - up period, duration of symptoms, occupying ratio,levels of OPLL, preoperative JOA scores, complications, postoperative JOA scores, the recovery rate of JOA scores, and the excellent rate of operation, but there were two cases of eerebrospinal fluid （CSF） leaks in anterior group, while no one in posterior group. Conclusion The short - term clinical results of patients with cervical OPLL treated by cervical anterior corpectomy with fusion and internal fixation or posterior laminectomy are satisfactory. The anterior group and posterior group have no significant differences in elinical resuhs. The choice of surgical approach should depend on the charaeteristics of patients and surgeon＇s experience.