伴后纵韧带骨化颈椎过伸性损伤的手术治疗

Surgical treatment of hyperextension injury of cervical spine with ossification of posterior longitudinal ligament

目的探讨伴有后纵韧带骨化颈椎过伸性损伤的临床特点及手术方式。方法对自2007-07—2013-11行手术治疗且病历资料完整的13例伴有后纵韧带骨化(OPLL)颈椎过伸性损伤患者的临床资料进行回顾性分析。根据病历及影像资料判断后纵韧带骨化类型及范围;椎间盘韧带复合体(DLC)损伤致不稳节段;分析各患者DLC损伤不稳节段与脊髓损伤的特点及手术方式的异同。结果 13例伴有后纵韧带骨化颈椎过伸性损伤患者均有脊髓及DLC损伤。其术前脊髓功能Frankel分级:A级2例,B级3例,C级5例,D级3例;DLC损伤节段数:9例为1个,4例为2个。手术方式:前路5例,后路5例,前后联合入路3例。术后3个月Frankel分级:6例提高1级,7例无变化。结论伴后纵韧带骨化颈椎过伸性损伤患者手术方式的选择,应结合OPLL的分型、DLC损伤的位置、脊髓损伤的范围,充分减压并重建稳定。

Objective To investigate the clinical features and surgical managements of the hyperextension injury of the cervical spine with the ossification of posterior longitudinal ligament. Methods From July 2007 to November 2013, 13 patients with hyperextension injury of the cervical spine with the ossification of posterior longitudinal ligament（OPLL） were treated and the medical records were retrospectively analyzed. According to the medical records and image data the type and extent of the OPLL were determinedas well as the unstable segments caused by the disco-ligamentous complex（DLC） injury;the characteristics and differences between surgical methods of the unstable segment of the DLC injury and the spinal injury of each patients were analyzed. Results Thirteen cases of the hyperextension injury of the cervical spine with OPLL all had spinal and DLC injury： the preoperative spinal function Frankel grade： 2 cases were grade A, 3 cases grade B, 5 cases grade C, 3 cases grade D; the number of segments of DLC injury： one in 9 cases, two in 4 cases. Surgical methods： 5 cases were in anterior approach, 5 cases were in posterior approach, and 3 cases were in combined way. Three months after operation, the Frankel grade： 6 cases raised by one grade and 7 had no change. Conclusion The selection of the surgical management of patients, who had hyperextension injury of the cervical spine with OPLL, should be combined with the type of OPLL, the position of DLC injury, the extent of the spinal injury, and should decompress completely and reconstruct the stability.