“安全减压间隙”在前路椎体次全切除治疗颈椎后纵韧带骨化症中的应用

The application of ＂safe decompression area＂ between ligament and dura mater in the treatment of cervical ossification of the posterior longitudinal ligament via anterior corpectomy

目的探讨后纵韧带与硬脊膜间“安全减压间隙”在前路椎体次全切除术治疗颈椎后纵韧带骨化症（OPLL）中的应用价值。方法回顾性分析2010年1月—2014年1月第二军医大学附属长征医院脊柱外科行颈椎前路椎体次全切除治疗的134例颈椎OPPL患者临床资料，其中男88例，女46例；年龄35—71岁，平均（50．5±16．7）岁。术前CT矢状面显示节段型105例，连续型12例，混合型17例，骨化均不超过3个椎体。术中以韧带未骨化处为突破口，使用后纵韧带钩钩起骨化物，形成后纵韧带与硬脊膜间“安全减压间隙”，锐利神经剥离子仔细分离，超薄型枪钳逐步咬除骨化的韧带。术中观察有无硬脊膜粘连及破损而导致脑脊液漏以及脊髓损伤，采用JOA评分评估患者术前、术后神经功能改善程度。结果CT横断面上椎管狭窄率〈30％者58例，利用“安全减压间隙”行骨化物切除术，无硬膜破损；30％-60％之间者62例，1例硬脊膜破损导致脑脊液漏；〉60％者14例，4例脑脊液漏。术中发现硬脊膜粘连97例，在“安全减压间隙”下用锐利神经剥离子成功分离92例。患者均未出现脊髓损伤，术后JOA评分（14．9±2．7）分，较术前（9．3±1．9）分有显著改善，差异有统计学意义（t=2．210，P〈0．05）。结论利用后纵韧带钩钩起骨化后纵韧带创造“安全减压间隙”，可有效地分离后纵韧带与硬脊膜的粘连，避免骚扰脊髓，减少硬脊膜破损及脊髓损伤。

Objective To discuss the application of ＂ safe decompression area＂ between posterior longitudinal ligament （PLL） and dura mater in the treatment of cervical ossification of the posterior longitudinal ligament （OPLL） via anterior corpectomy. Methods From January 2010 to January 2014, 134 patients of cervical OPLL （88 males and 46 females ） underwent anterior corpectomy were performed retrospective study. The average age was （50.5 ± 16.7） , ranging from 35 to 71 years old. There were 105 segmental-type, 12 continous-type and 17 mixed-type OPLL on sagittal CT, with all less than 3 segments. The ligament hook was inserted under the PLL through the non-ossified location. The PLL was hooked, and then a ＂safe decompression area＂ appeared between the PLL and dura mater. A Kerrison rongeur was used to resect the ossified PLL. The adhesion, cerebrospinal fluid （CSF） leakage and spinal cord injury were recorded. The Japanese Orthopaedic Association （JOA） scoring system was used to evaluate the neurological status before and after operation. Results There were 58 patients with an occupying rate less than 30% , 62 patients between 30% and 60% , and 14 patients more than 60%. The ossified ligaments was resected under the ＂safe decompression area＂. There were 5 patients presenting with CSF leakage after operation, one of which belonged to patients with 30% to 60% occupying rate and others belonged to cases with more than 60%. There were 97 patients with adhesion between PLL and dura mater, of which 92 patients were meticulously separated using the micro dissector. No patient presented with spinal cord injury. The postoperative JOA score was （ 14. 9 ±2. 7 ） points, having a significant improvement compared with preoperation （9.3± 1.9 ） points （ t = 2. 210, P 〈 0.05 ）. Conclusions The adhesion can be separated and has less excitation to the spinal cord under ＂safe decompression area＂ between PLL and dura mater.