硬脊膜松解对椎管扩大成形术治疗伴后纵韧带骨化的多节段脊髓型颈椎病疗效的影响

EFFECT OF SPINAL DURAL RELEASE ON TREATMENT OF MULTISEGMENTAL CERVICAL MYELOPATHY WITH OSSIFICATION OF POSTERIOR LONGITUDINAL LIGAMENT BY CERVICAL LAMINOPLASTY

目的探讨硬脊膜松解对颈后路椎管扩大成形术治疗伴后纵韧带骨化的多节段脊髓型颈椎病疗效的影响。方法回顾分析2011年2月-2013年10月,32例行椎管扩大成形术联合硬脊膜松解的伴后纵韧带骨化的多节段脊髓型颈椎病患者临床资料（A组）,并与2010年1月-2011年1月36例单纯行椎管扩大成形术的患者（B组）进行比较。两组性别、年龄、病程、累及节段、合并内科疾病以及术前颈椎屈曲度、日本骨科协会（JOA）评分、疼痛视觉模拟评分（VAS）比较,差异均无统计学意义（P〉0.05）,具有可比性。比较两组术后JOA评分及其改善率、VAS评分以及脊髓后移距离、颈椎曲度变化。结果术中3例出现硬脊膜撕裂,其中A组2例、B组1例;术后3例发生脑脊液漏,其中A组2例、B组1例。患者均获随访,随访时间12~46个月,平均18.7个月。末次随访时,两组JOA评分及VAS评分均较术前显著改善（P〈0.05）;A组JOA评分及改善率显著高于B组（P〈0.05）,VAS评分显著低于B组（P〈0.05）。末次随访时,两组颈椎曲度比较差异无统计学意义（P〉0.05）;A组脊髓后移距离大于B组（P〈0.05）。随访期间均未出现椎板再关门。结论对伴后纵韧带骨化的多节段脊髓型颈椎病,颈后路椎管扩大成形术中进行充分硬脊膜松解,有利于脊髓后移,与单纯椎管扩大成形术相比,疗效显著提高。

Objective To explore the effect of spinal dural release on the effectiveness of expansive cervical laminoplasty for treating multi-segmental cervical myelopathy with ossification of posterior longitudinal ligament. Methods A retrospective analysis was made on the clinical data of 32 patients with multi-segmental cervical myelopathy with cervical ossification of posterior longitudinal ligament who underwent expansive cervical laminoplasty and spinal dural release between February 2011 and October 2013（group A）; and 36 patients undergoing simple expansive cervical laminoplasty between January 2010 and January 2011 served as controls（group B）. There was no significant difference in gender, age, disease duration, affected segments, combined internal disease, preoperative cervical curvature, Japanese Orthopaedic Association（JOA） score, and visual analogue scale（VAS） score between 2 groups（P〈0.05）. Postoperative JOA score and improvement rate, VAS score, posterior displacement of the spinal cord, and the change of cervical curvature were compared between 2 groups. Results Spinal dural tear occurred in 3 cases（2 cases in group A and 1 case in group B） during operation. Cerebrospinal fluid leakage occurred in 3 cases（2 cases in group A and 1 case in group B） after operation. The patients were followed up 12-46 months（mean, 18.7 months）. At last follow-up, the JOA score and VAS score were significantly improved in 2 groups when compared with preoperative scores（P〈0.05）. JOA score and improvement rate of group A were significantly higher than those of group B（P〈0.05）, but VAS score of group A was significantly lower than that of group B（P〈0.05）. At last follow-up, no significant difference in cervical curvature was found between 2 groups（P〈0.05）; posterior displacement of the spinal cord of group A was significantly larger than that of group B（P〈0.05）. No reclosed open-door was observed during follow-up. Conclusion For patients with multi-segmental cervical myelopathy with ossification of posterior longitudinal ligament, full spinal dural release during expansive cervical laminoplasty can increase the posterior displacement of spinal cord, and significantly improve the effectiveness.