后路手术治疗过伸位K线阳性颈椎后纵韧带骨化症的疗效

Clinical efficacy of posterior surgery for cervical ossification of posterior longitudinal ligament with K-line positive in extension radiograph

目的观察后路减压手术治疗过伸位K线阳性颈椎后纵韧带骨化症(OPLL)的临床疗效。方法回顾性分析2005年2月至2012年1月第二军医大学附属长征医院收治的72例OPLL患者的临床资料,其中27例行椎板成型术、45例行椎板切除减压内固定术。根据OPLL骨化最高点相对于K线的位置,分为K线阳性组(标准侧位片K线阳性,39例)和过伸位K线阳性组(标准侧位片K线阴性但过伸位侧位片K线阳性,33例)。记录术前和术后1年两组患者的日本骨科学会(JOA)评分,计算恢复率。结果术后1年,K线阳性组JOA评分由术前的(11.3±2.9)分提高到(14.2±3.0)分(P<0.05),过伸位K线阳性组JOA评分由术前的(10.5±1.8)分提高到(13.3±2.7)分(P<0.05),但术前、术后JOA评分组间比较,差异无统计学意义(P>0.05);K线阳性组和过伸位K线阳性组恢复率分别为(51±22)%和(44±23)%,两组比较,差异无统计学意义(P>0.05)。结论对过伸位K线阳性颈椎OPLL患者施行后路手术可以获得与K线阳性患者相当的临床疗效。

Objective To evaluate the clinical effects of posterior surgery for cervical ossification of posterior longitudinal ligament （OPLL） with K-line positive in extension lateral X-ray film. Methods Seventy-two patients with cervical OPLL underwent posterior laminoplasty （27 patients） or laminectomy （45 cases） in Changzheng Hospital of the Second Military Medical University from February 2005 to January 2012, and their clinical data were reviewed retrospectively. According to the position relation of K-line and the range of OPLL, patients were classified into 2 groups, K-line positive group （OPLL not beyond K-line, 39 cases） and group of K-line positive in extension radiograph （OPLL beyond K-line in normal lateral X-ray film but not＆amp;nbsp;beyond K-line in extension lateral film, 33 cases）. Japanese Orthopaedic Association （JOA） scores before surgery and 1 year after surgery were recorded, the improvement rate was calculated. Results Average of JOA score in K-line positive group was improved from preoperative （11.3 ± 2.9） to （14.2 ± 3.0） at 1 year after operation （P〈0.05）, the average score in group of K-line positive in extension radiograph was also improved from preoperative （10.5 ± 1.8） to （13.3 ± 2.7） at 1 year after operation （P 〈0.05）; While the differences of preoperative, postoperative JOA scores between two groups had no statistical significance respectively （P 〉0.05）. The mean improvement rate was （51 ± 22） % in K-line positive group and （44 ± 23） % in group of K-line positive in extension radiograph, there is no statistical difference between two groups （P 〉0.05）. Conclusion Cervical OPLL patients with K-line positive in extension X-ray film could achieve similar clinical outcome compared with K-line positive patients.