颈椎后纵韧带骨化症的手术疗效及影响因素分析

Surgical efficacy and affecting factor analysis on cervical ossification of the posterior longitudinal ligament

目的 探讨手术治疗颈椎后纵韧带骨化症（OPLL）的疗效及其影响因素.方法 选择行颈椎前路椎体融合内固定术或后路椎板切除术治疗的颈椎OPLL患者22例,将JOA改善率为优和良的定为疗效优,中和差的定为疗效差,分别将手术时年龄、脊髓压迫症病程、术前脊髓压迫症状严重程度（术前JOA评分及其分级）、有无合并糖尿病、手术入路、OPLL分型、椎管狭窄率等因素进行统计学分析,并将手术时年龄、术前JOA评分、病程3个因素进行二分类logistic回归分析.结果 所有患者均获9~38个月随访.手术后,JOA评分显著提高（P〈0.001）,总计增加（4.77±2.86）分,JOA改善率为（72.25±33.41）%,手术优良率为77%.脊髓压迫症病程是唯一与手术疗效相关的因素,logistic回归分析结果也显示长病程是手术疗效差的独立危险因素（OR=1.035,P〈0.05）,病程越长,疗效越差.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全椎板切除减压术的手术短期疗效是满意的.脊髓压迫症的病程过长是手术疗效差的独立危险因素,应在出现脊髓压迫症时尽早手术治疗.

Objective To evaluate the clinical efficacy on patients with ossification of cervical posterior longitudinal ligaments （OPLL） treated surgically, and to analyze the affecting factors. Methods Twenty two cases of OPLL were performed by cervical anterior eorpectomy with fusion and internal fixation, or posterior laminectomy alone. The patients were classified into good - prognosis group and poor - prognosis group according to the recovery of JOA score. The possible prognostic factors were statistically studied, such as age, duration of symptoms, severity of disease （preoperative JOA scores and grade） , occupying ratio, type of OPLL, surgical approach, and diabetes mellitus; while age, duration of symptoms, and preoperative JOA scores were selected for further binary logistic regression. Results The follow - up period ranged from 9 to 38 months. The postoperative JOA score was significantly elevated by 4.77 ±2. 86 （ P 〈 0. 001 ）. The recovery rate was （72. 25 ±33.41 ）% , with excellent rate of operation was 77%. The binary logistic regression analysis revealed that duration of symptoms was the only significant factor affected the efficacy of surgical treatment （ OR = 1. 035, P 〈 0, 05 ）. The longer the duration of symptoms, the worse the efficacy would be. Conclusion The short - term clinical results of patients with OPLL treated by cervical anterior corpectomy with fusion and internal fixation or posterior laminec- tomy are satisfied. Duration of spinal compression is the independent risk factor of bad prognosis in surgical treatment.