伴椎间盘突出的颈椎后纵韧带骨化症的特点与治疗

Clinical features and surgical treatment of ossification of the posterior longitudinal ligament combined with cervical disc herniation

[目的]探讨伴有颈椎间盘突出(cervical disc herniation,CDH)的颈椎后纵韧带骨化症(ossification of the posterior longitudinal ligament,OPLL)患者的临床特点及前路手术疗效。[方法]2011年1月~2014年1月,应用前路手术治疗颈椎OPLL患者78例,其中19例伴有CDH,比较伴有与不伴有CDH患者的资料。14例CDH位于骨化韧带节段范围内,行前路椎体次全切除术;5例CDH位于骨化韧带的相邻节段,行椎体次全切除并椎间隙减压的"混合式"手术。随访观察患者的神经功能、椎管狭窄率、脊髓扁平率、颈椎曲度等变化。[结果]与普通OPLL患者相比,伴有CDH者病程较短,多在诱因下起病或加重,突出的椎间盘是重要压迫因素。19例患者平均随访24个月,JOA评分由术前9.16分提高至末次随访时的13.84分,差异有统计学意义(P<0.05),平均神经功能恢复率为61.55%。颈椎曲度由术前的9.34°提高至随访时的15.19°,椎管狭窄率从术前的38.95%下降至术后的8.47%,脊髓扁平率从术前的0.26恢复至随访时的0.49,术前术后相比上述指标差异均具有统计学意义(P<0.05)。术后2例患者出现脑脊液漏,1例出现C5神经根麻痹,均经保守治疗痊愈。[结论]颈椎间盘突出可造成颈椎后纵韧带骨化症患者临床症状的突然出现或加重,根据椎间盘突出与骨化物的位置关系,选择前路手术治疗可获得满意临床疗效。

[Objective] To discuss the clinical features and surgical outcome of cervical ossification of the posterior longi- tudinal ligament （OPLL） associated with cervical disc herniation （CDH） . [Methodsl Between January 2011 and January 2014, 78 patients with radiologically proven OPLL were enrolled in this study. Of them, 19 patients were complicated with CDH, while the remaining 59 patients proved no associated with CDH. Amomg the 19 patients with OPLL and CDH, 14 pa- tients who had CDH within the segments of OPLL received anterior corpectomy and fusion （ACCF）, whereas 5 patients with CDH adjacent to OPLL segment were treated with ACCF combined with anterior diseectomy and fusion （ACDF） . The neuro- logical function, occupying ratio （OR）, cord flattening rate and cervical lordosis were measured for evaluation of clinical out- come. [Results] Compared with the patients without CDH, the illness course of the patients combined with CDH progressed more quickly （P〈0.05）, which usually flared up with the CDH as the major compression factor. The 19 patients were followed up for an average of 24 months. The mean JOA score increased from 9.16 preoperatively to 13.84 at final follow-up （P〈0.05） with an improvement rate of 61.55%. Additionally the mean OR decreased from 38.95% preoperatively to-8.47% postoperatively （P〈0.05）, the cervical lordosis increased from 9.34 degrees preoperatively to 15.19 degrees at the last follow-up （P〈0.05）, as well as the cord flattening rate increased from 26% preoperatively to 49% at the last follow-up （P 〈0.05） . Cerebrospinal fluid （CSF） leakage was found in 2 patients and Cs palsy occurred in 1 patient, but both of them recovered spontaneously af- ter conservative treatment. [Conclusion] The clinical symptoms of the patients with OPLL may Suddenly appear Or aggravate due to CDH. Based on the location relationship betweeYr OPLL and CDH, the proper anterior surgical decompressions do achieve satisfactory outcomes.