后路手术治疗颈胸段后纵韧带骨化症的早期疗效观察

Early clinical results of posterior approach surgery for ossification of the posterior longitudinal ligament in cervicothoracic junction

目的观察颈胸段后纵韧带骨化症(OPLL)的后路手术治疗效果并总结其治疗策略。方法回顾分析2015年1月至2018年1月天津医院行手术治疗的颈椎OPLL患者298例。其中14例为颈胸段OPLL,平均年龄62.6岁(47~68岁),男8例,女6例,其中12例为初次手术,2例为翻修手术。14例患者的OPLL分型包括8例连续型OPLL和6例混合型OPLL。所有患者均一期接受手术治疗。记录患者的手术时间、术中出血量和术后并发症发生情况。术后1、3、6、12和24个月进行随访,采用改良JOA评分、JOA改善率和Nurick脊髓功能评分评估治疗效果,同时通过X线片测量患者术前和术后颈椎前凸角,通过侧位CT重建测量最大OPLL椎管占位率,并评估术后骨化的进展。结果随访6~24个月,平均12.4个月。所有患者末次随访JOA评分较术前均有不同程度改善,3例改善率为优,3例改善率为良,8例改善率为有效,平均JOA改善率为46.1%。颈椎前凸角术前为(24.0±7.8)°,末次随访为(15.0±6.3)°,二者差异无统计学意义(P=0.15)。最大OPLL椎管占位率术前为(67.3±12.0)%,末次随访为(70.2±11.1)%,二者差异无统计学意义(P=0.68)。结论对伴有脊髓压迫症状的颈胸段OPLL行后路减压手术相对安全,临床疗效确切。对于如何选择OPLL减压后的固定融合节段尚有争议。

Objective To observe the early clinical results of posterior approach surgery for ossification of the posterior longitudinal ligament（OPLL）in cervicothoracic junction.Methods From January 2015 to January2018,298 cases of cervical OPLL were surgical treated.Of which 14 cases were OPLL in cervicothoracic junction with an average age of 62.6 years（47-68 years）.There were 8 males and 6 females.Two of the cases had a history of cervical spine surgery.Types of OPLL in the 14 cases included 8 continuous OPLL and 6 mixed OPLL.All the 14 patients were treated by surgery via posterior approach.The operation time,the amount of intraoperative blood loss and postoperative complications were recorded.Patients were followed up at one month,3,6,12 and 24 months postoperatively.The clinical results were evaluated by revised JOA score,rate of JOA improvement and Nurick score.The lordosis of cervical spine and the maximal OPLL occupancy rate were evaluated on lateral X-ray or reconstruction CT.The progression of OPLL was calculated by comparing the preoperative OPLL occupancy rates and that at last follow-up.ResultsAll patients were followed up for average 12.4 months（6-24 months）.The JOA scores were improved in all patients after surgery.The rates of JOA improvement were 3 excellent,3 good and 8 effective,with an average of 46.1%.The cervical lordosis were（24.0±7.8）°preoperatively and（15.0±6.3）°at the final follow-up,and the difference was not statistically significant（P=0.15）.The maximal OPLL occupancy rates were（67.3±12.0）%preoperatively and（70.2±11.1）%at the last follow-up,and the difference was not statistically significant（P=0.68）.Conclusion The short-term efficacy of posterior decompression surgery for cervicothoracic junction OPLL is good.The determination of fixed segments remains controversial.