分期治疗颈椎黄韧带骨化合并后纵韧带骨化症

Clinical Effect of Staged Combined Posterior-anterior Approach on Severe Ossification of Ligamentum Flavum Accompanied with Posterior Longitudinal Ligament

目的回顾性分析分期后前路手术治疗颈椎黄韧带骨化（ossification of ligamentum flavum,OLF）合并后纵韧带骨化（ossification of the posterior longitudinal ligament,OPLL）的临床疗效。方法完整随访手术治疗的颈椎OLF合并OPLL患者18例,一期行后路椎板成形术,术后严密观察6-9个月,一期术后症状改善有限,影像学检查发现前方骨化的韧带压迫脊髓,二期行前路椎体次全切除并切除骨化的韧带＋植骨内固定术。术前、一期和二期术后行JOA评分并计算恢复率,测量颈椎前凸值,比较术前、术后颈椎前凸值、JOA评分和恢复率。结果椎板成形术后出现不全瘫痪症状加重者1例,C5神经根麻痹症状1例,脑脊液漏3例;二期前路手术后出现脑脊液漏2例,神经根麻痹2例,保守治疗后痊愈。平均随访时间26.3个月,术前JOA评分（7.2±1.3）分,颈椎前凸值（5.7±4.1）°;一期术后JOA评分（12.6±3.8）分,改善率为（51.6±19.3）%,颈椎前凸值（9.3±3.8）°;二期术后JOA评分（14.8±1.6）分,改善率为（72.7±13.4）%,颈椎前凸值（15.5±3.2）°。JOA评分、改善率以及颈椎前凸值在一期、二期术后与术前相比差异均有统计学意义,P〈0.05。结论分期后前路手术治疗可明显改善OLF合并OPLL患者术后JOA评分、恢复率和颈椎前凸值,是治疗OLF合并OPLL的一种良好方式。

Objective To retrospective analyze the clinical outcome of staged combined posterior-anterior approach for ossification of ligamentum flavum（OLF） accompanied with posterior longitudinal ligament（OPLL） complicated with cervical spondylotic myelopathy.Methods 18 patients with OLF accompanied with OPLL complicated with cervical spondylotic myelopathy who undernent posterior laminoplasty,anterior decompression,bone graft and internal fixation between June 2009 and June2011 were reviewed retrospectively.Ventral compression of ossifications still presented on radiograph in 6 to 9 months after surgery in all cases,anterior corpectomy and dissection of OPLL as well as bone graft was then conducted.JOA,RR and cervical lordosis was used to evaluate the pre-and post-operation score and follow-up outcome.Results 1 cases presented C5 nerve root paralysis after posterior approach,3 cases were complicated with CSF leakage which resolved by conservative treatment.The mean follow-up time was 26.3 months.The preoperative mean scores of JOA was 7.2 ± 1.3,cervical lordosis was（5.7 ±4.1） °and JOA was（12.6 ± 3.8） for posterior approach with the mean improvement ratio of（51.6 ± 19.3） %,cervical lordosis was（9.3 ± 3.8） °.The mean JOA scores after anterior decompression was 1 4.8 ± 1.6 with the mean improvement ratio of（72.7 ±13.4） % compared with preoperation,cervical lordosis was（15.5 ±3.2） °.Conclusion Patient with OLF accompanied with OPLL complicated with cervical spondylotic myelopathy undergoing posterior decompression have good clinical outcome after anterior approach operation if still presenting ventral compression.Staged combined posterior-anterior approach is a better method for patient with OLF accompanied with OPLL complicated with cervical spondylotic myelopathy.