颈椎前路椎体骨化物复合体前移融合术再手术治疗颈椎后纵韧带骨化症效果观察(附12例分析)

Anterior controllable anteriodisplacement and fusion for reoperation treatment of cervical ossification of posterior longitudinal ligament: an observation of efficacy in 12 cases

目的探讨颈椎前路椎体骨化物复合体前移融合术(ACAF)对颈椎后纵韧带骨化症颈椎后路手术治疗后疗效不佳或症状加重患者的治疗效果。方法选择2016年2月至2017年2月在我院住院治疗的既往因颈椎后纵韧带骨化症行颈椎后路手术治疗后疗效不佳或症状加重患者12例,其中男7例、女5例,年龄52~74岁,平均(63.92±6.54)岁,再次手术均采用ACAF术式。采用日本骨科协会(JOA)评分和视觉模拟量表(VAS)评分评估患者ACAF术前及术后3、6、12个月和末次随访时的神经功能和疼痛情况。结果 12例患者均获得随访,随访9~21个月,平均(14.92±3.75)个月。所有患者ACAF术后神经功能均得到不同程度恢复,JOA评分由术前9.33±1.93升高为末次随访时的14.67±2.01,差异有统计学意义(t=3.184,P<0.05),患者神经功能改善率为(71.9±21.8)%;VAS评分由术前5.25±1.42降低至末次随访时的0.92±0.83,差异有统计学意义(t=4.025,P<0.05)。结论 ACAF作为颈椎后纵韧带骨化症的翻修手术初步取得了较好的临床疗效,能够有效改善患者的神经功能,可作为颈椎后纵韧带骨化症翻修手术的选择方案之一。

Objective To evaluate the surgical outcomes of anterior controllable anteriodisplacement and fusion（ACAF） for the reoperation of the cervical ossification of posterior longitudinal ligament（OPLL）. Methods Twelve cervical OPLL patients aged 52-74（63.92±6.54） years, who had poor curative effect or aggravated symptoms after posterior decompressive surgery, were included in this study, with 7 males and 5 females. All patients underwent reoperation with ACAF between Feb. 2016 and Feb. 2017. The Japanese Orthopaedic Association（JOA） score and visual analogue scale（VAS） were used to evaluate neurological function and pain preoperatively and 3, 6, 12 months postoperatively and at final follow-up. Results The patients were followed up for 9-21 months（average [14.92±3.75] months）. The neurological function was recovered to varying degrees after ACAF in all patients. The JOA score was significantly improved from 9.33±1.93 preoperatively to 14.67±2.01 at final follow-up（t=3.184, P〈0.05）, and the neurological function recovery rate was（71.9±21.8）%. The VAS score was significantly decreased from 5.25±1.42 preoperatively to 0.92±0.83 at final followup（t=4.025, P〈0.05）. Conclusion The outcomes of ACAF for the reoperation of cervical OPLL are satisfactory. ACAF significantly improves the patients’ neurological function, and it is an alternative surgical treatment of the reoperation for cervical OPLL.