前后路联合手术治疗黄韧带肥厚并后纵韧带骨化的颈椎病患者17例

Combined anterior and posterior surgery for 17 cases of cervical spondylosis with hypertrophy of ligamentum flavum and ossification of posterior longitudinal ligament

目的 探讨黄韧带肥厚并后纵韧带骨化的颈椎病患者行一期前后路手术临床疗效。方法 自2012年5月-2017年1月收治黄韧带肥厚并后纵韧带骨化的颈椎病患者17例,均采用一期前后路联合手术,首先予以俯卧位进行后路减压、黄韧带切除,而后翻转体位,予以前路减压椎间植骨融合处理。结果 17例患者均顺利完成前后路联合减压手术,术后未发生脑脊液漏、神经根误伤或切口感染等并发症。所有患者均获随访1年以上,术后3、12个月的JOA评分、颈椎曲度和椎管前后径均有显著提高(P<0.05),颈椎活动度则有显著降低(P<0.05);术后3个月的椎管扩大率为(49.06±7.34)%,术后12个月为(48.25±6.23)%。结论 一期前后路联合手术治疗黄韧带肥厚并后纵韧带骨化的颈椎病患者,手术安全性较好,减压效果可靠,且可重建颈椎稳定性,可取得较好疗效。

Objective To investigate the clinical efficacy of one-stage anterior and posterior surgery for cervical spondylosis with hypertrophy of ligamentum flavum and ossification of posterior longitudinal ligament. Methods Seventeen cases of cervical spondylosis with ligamentum flavum hypertrophy and ossification of the posterior longitudinal ligament were treated from May 2012 to January 2017. All patients were treated with anterior and posterior approach combined operation. First, the posterior decompression, ligamentum resection and the body position were performed in the prone position, and the anterior decompression and interbody fusion were performed. Results All 17 patients successfully completed the anterior and posterior combined decompression operation. No cerebrospinal fluid leakage, nerve root injury or incision infection occurred after operation. All patients were followed up for more than 1 year. The JOA score, cervical curvature and spinal canal diameter were significantly increased at 3 and 12 months after operation ( P <0.05), and the activity of cervical vertebra decreased significantly ( P <0.05). The expansion rate of spinal canal at 3 months after operation was (49.06±7.34)%, and at 12 months after operation was (48.25±6.23)%. Conclusion The treatment of cervical spondylosis with yellowish toughening and posterior longitudinal ligament ossification by combined anterior and posterior approach is safe and reliable, and can reconstruct the stability of the cervical vertebra, and a better effect can be obtained.