颈椎后路单开门联合椎间孔切开术治疗颈椎后纵韧带骨化的疗效分析

Analysis of clinical efficacy of unilateral open door cervical laminoplasty combined with foraminotomy for cervical ossification of posterior longitudinal ligament

目的 :探讨颈椎后路单开门联合椎间孔切开术在治疗颈椎后纵韧带骨化中临床疗效。方法 :对2011年9月至2015年9月收治的45例颈椎后纵韧带骨化症患者进行回顾性研究,其中男26例,女19例;年龄28~71岁,平均53.6岁;24例采用后路单开门椎管扩大成形联合椎间孔切开术治疗(联合椎间孔切开组),21例采用单纯后路单开门椎管扩大成形术治疗(单纯单开门组)。比较两组患者的手术时间、术中出血、C_5神经麻痹及轴性症状发生情况;观察两组患者手术前后的JOA评分并计算神经功能改善率;分析两组患者的NDI评分及颈椎Cobb角的变化。结果:两组患者术后均获得随访,时间12~24个月,其中联合椎间孔切开组平均随访时间为(14.3±2.8)个月,单纯单开门组为(13.7±3.1)个月,两组比较差异无统计学意义(P>0.05)。两组患者在手术时间、术中出血方面差异均无统计学意义(P>0.05)。两组患者术后JOA评分较术前均明显提高(P<0.05),但两组改善率比较差异无统计学意义(P>0.05)。末次随访时联合椎间孔切开组和单纯单开门组的NDI评分分别为13.6±1.8和16.1±2.4,两组比较差异有统计学意义(P<0.05);C_5神经麻痹发生率分别为4.2%(1/24),28.6%(6/21),两组差异有统计学意义(P<0.05);轴性症状发生率分别为8.3%(2/24),9.5%(2/21),两组差异无统计学意义(P>0.05)。末次随访时两组患者的颈椎Cobb角与术前比较差异无统计学意义(P>0.05),组间比较差异也无统计学意义(P>0.05)。结论:颈椎后路单开门扩大椎管成形联合椎间孔切开术不仅能够充分的解除脊髓压迫,亦可扩大椎间孔,松解受压神经根,缓解根性症状,同时在预防C_5神经根麻痹等并发症的出现亦取得了良好的效果,是一种治疗伴有神经根症状的颈椎后纵韧带骨化症有效方法。

Objective：To explore the clinical efficacy of unilateral open door laminoplasty combined with foraminotomy for cervical ossification of posterior longitudinal ligament（OPLL）. Methods：The clinical data of 45 patients with OPLL underwent surgical treatment between September 2011 and September 2015 were retrospectively analyzed. There were 26 males and19 females with a mean age of 53.6 years old（ranged from 28 to 71 years）. Among them,24 cases received the surgery of unilateral open door cervical laminoplasty combined with foraminotomy（combined group）,and 21 cases received a single unilateral open door cervical laminoplasty（single group）. Operation time,intraoperative blood loss,complications including C_5 nerve root palsy and axial symptoms were compared between two groups. Pre and post operative Japanese Orthopedic Association（JOA） score,improvement rate of neurological function,Neck Disability Index（NDI） score,and cervical Cobb angle were recorded and analyzed between the two groups. Results：All the patients were followed up for 12-24 months,with an average of（14.3±2.8） months for combined groups and（13.7±3.1） months for single group,and no significant difference was found between the two groups（P〈0.05）. There was no significant difference in operation time and intraoperative blood loss between two groups（P〈0.05）. Postoperative JOA scores obtained obvious improvement in all patients（P〈0.05）. However,there was no significant difference between two groups for the improvement rate of neurological function（P〈0.05）. At final follow up,NDI scores of combined group and single group were 13.6±1.8 and 16.1±2.4 respectively,there was significant difference between two groups（P〈0.05）. The incidence of C_5 nerve root palsy was lower in combined group（4.2%） than that of single group（28.6%）. There was no significant difference in incidence rate of axial symptoms between two groups（P〈0.05）. There was no significant difference in cervical Cobb angle between pre and post operative conditions,or between two groups（P〈0.05）.Conclusion：Unilateral open door cervical laminoplasty combined with foraminotomy is an effective method to treat cervical OPLL,which could provide sufficient decompression of spinal cord and nerve root,prevent the C_5 nerve root palsy.