一期前后联合手术与单纯后路手术治疗重度颈椎后纵韧带骨化症临床疗效的差异分析

Comparison of clinic outcome of severe cervical ossification of the posterior longitudinal ligament (OPLL) between laminoplasty and posterior laminoplasty (or laminotomy) combined with anterior decompression and fusion

[目的]比较前后路联合手术与单纯后路手术治疗重度颈椎后纵韧带骨化症临床疗效及影像学改变的差异,探讨重度颈椎后纵韧带骨化症手术方式的选择策略。[方法]38例资料完整的重度颈椎后纵韧带骨化患者,接受前后路联合手术13例,接受单纯后路手术25例。记录两组术后并发症,并对两组术后颈椎曲度Cobb角变化及JOA评分改善率进行比较;根据Fujiyoshi介绍的K线法对所有患者进行分类,分别比较在K线阳性和K线阴性组患者两种手术策略疗效的差异。[结果]单纯后路手术组中出现椎管内血肿1例,浅表感染1例,C5神经根麻痹2例;前后联合手术组中脑脊液漏3例,喉返神经损伤1例;后前路联合手术组颈椎Cobb角由术前平均7.1°增加至末次随访时的11.3°,单纯后路手术组颈椎Cobb角由术前的平均7.3°至末次随访时的平均3.7°,两组颈椎Cobb角变化有显著性差异(P<0.05);两组患者手术前后JOA评分及改善率均无显著性差异(P>0.05),K线阴性患者中后前联合入路手术组JOA评分改善率显著高于单纯后路手术组。[结论]后前路联合手术与单纯后路手术治疗重度颈椎后纵韧带骨化症总体临床疗效无显著差异;后前路联合手术能够更好的恢复颈椎曲度;K线是重度颈椎后纵韧带骨化症手术策略选择的重要指标。

[ Objective ] To compare the clinic outcome and radiological features of severe cervical ossification of the posterior longitudinal ligament （OPLL） between two different surgical treatment, laminoplasty and posterior laminoplasty （or laminotomy） combined with anterior decompression and fusion, in order to discuss the surgical strategy for severe cervical ossification of the posterior longitudinal ligament. [ Methods] Thirty -eight OPLL cases underwent two different surgical treatment, 25 cases were accepted laminoplasty, 13 cases underwent posterior laminoplasty （or laminotomy） combined with anterior decompression and fusion. The complications, the change cervical alignment, and the recover rate of JOA score were compared between the two groups. Thirty - eight OPLL case were divided into K - Line （ ＋ ） group and K - Line （ - ） group, according to the K - Line classification introducted by Fujiyoshi. The recover rate of JOA score were compared between two surgical treatment in either K - Line （ ＋ ） group or K - Line （ - ） group. [ Results] Hematoma （ 1 case）, superficial infection （ 1 case）, and postoperative C -5 nerve palsy （2cases） were observed in laminoplasty group, while , eerebrospinal fluid leaks （3 cases） and recurrent laryngeal nerve injurys （1 case） were observed in posterior laminoplasty （or laminotomy） combined with anterior decompression and fusion group. Cervical lordosis angle （Cobb angle） increased from 7.1 ° preoperatively to 11.3 o in the cases who underwent posterior laminoplasty （or laminotomy） combined with anterior decompression and fusion, in the contrast, cervical lordosis angle decreased from 7.3°to 3.7°in the cases who underwent laminoplasty （ P 〈 0. 05 ） . In all 38 cases, there were not significant difference in recover rate of JOA score between two operative treatment groups. While , the recover rate of JOA score between two operative treatment groups were significantly different in K - Line （ - ） cases （ P 〈 0.05 ） . [ Conclusion ] In our series, there were not significant difirence in OPLL clinical outcome between laminoplasty group and posterior laminoplasty （ or laminotomy） combined with anterior decompression and fusion group. The latter showed better cervical alignment. The K - Line is a practical parameter to the chosen of surgical strategy.