保留单侧肌肉韧带复合体单开门椎管扩大成形术治疗颈椎后纵韧带骨化症对颈后肌群的影响

Effect on the morphological change in the posterior cervical muscle of laminoplasty with preservation of unilateral musculo-ligamentous complex in the treatment of patients with ossification of the posterior longitudinal ligament

目的:探讨颈后路保留一侧肌肉韧带复合体单开门椎管扩大成形术治疗颈椎后纵韧带骨化症对颈后肌群形态及组成的影响。方法:回顾性分析2015年1月~2017年8月在我院诊断为后纵韧带骨化症,并接受颈后路C3-7保留一侧肌肉韧带复合体单开门椎管扩大成形术的患者,收集患者年龄、性别、体重指数、颈椎曲度、活动度、颈部功能评分等临床指标及术后24个月相应临床指标,并在MRI上测量术前、术后24个月颈后部肌肉形态及组成。应用t检验,对比手术前、后颈后部肌群形态、成分变化。结果:16例患者入组,其中男性9例,女性7例,平均年龄52.94±7.07岁,其中局灶型后纵韧带骨化症6例,节段型5例,连续型5例。患者接受单开门椎管扩大成形术,术后患者颈椎曲度及椎间隙高度无显著变化,患者术前颈椎活动度平均40.33°±12.03°,术后为27.09°±11.09°,有显著差异(P<0.05)。对比手术前后,C3/4节段椎旁肌功能截面积(FCSA)及脂肪浸润(FI)存在显著差异(P<0.05),头夹肌FI存在显著差异(P<0.05)。C4/5及C5/6节段椎旁肌及头夹肌FCSA及FI均存在显著差异(P<0.05)。C6/7水平椎旁肌FCSA及FI存在显著差异(P<0.05),头夹肌在截面积(CSA)、FCSA及FI方面均存在显著差异(P<0.05)。对比术后左、右侧颈后部肌肉形态及成分,C3/4节段椎旁肌FI及头夹肌CSA右侧显著大于左侧;C4/5节段右侧头夹肌FI显著小于左侧;C5/6节段右侧椎旁肌CSA及FCSA显著大于左侧;C6/7节段椎旁肌FI右侧显著小于左侧。结论:在颈椎后纵韧带骨化症患者中,颈椎后路手术会显著增加颈椎后方椎旁肌及头夹肌脂肪浸润,缩小功能横截面积,保留一侧肌肉韧带复合体的单开门椎管扩大成形术可有效减少单侧肌肉的萎缩及脂肪浸润。

Objectives:To explore the influence of posterior cervical laminoplasty with preservation of unilateral musculo-ligamentous complex on posterior cervical muscles in patients with cervical ossification of the posterior longitudinal ligament(OPLL).Methods:Retrospectively reviewed patients diagnosed with cervical OPLL and received C3-7 laminoplasty with preservation of unilateral musculo-ligamentous complex in our institute.We collected clinical data such as age,gender,body mass index(BMI),C2-7 Cobb angle,cervical range of motion,cervical visual analog scale(VAS),mJOA score and neck disability index(NDI)with a minimal 24 months follow-up.The cross-sectional area(CSA),functional CSA(FCSA)and fatty infiltration(FI)of cervical posterior muscles in each segment were measured at pre-operation and 24 months after surgery.Ttest,Chi-square test were used for univariable test.Results:16 cases were included in this research,9 were male and 7 were female.The average age was 52.94±7.07 years old.Of all the patients,6 cases were diagnosed with OPLL of local type,5 were of segmental type,and 5 were of continuous type.2 years after surgery,there wasn′t any significant change in C2-7 Cobb angle and disc height.There was significant change of range of motion(ROM)pre-and post-operatively(40.33°±12.03°vs 27.09°±11.09°).Comparison was made between the posterior cervical muscles pre-and post-operatively,at C3/4 level,the FCSA was decreased and FI increased significantly in paraspinal muscle,FI increased significantly in splenius capitis(SC).At C4/5 and C5/6 level,FCSA and FI changed significantly in paraspinal muscle and SC.At C6/7 level,FCSA and FI in paraspinal muscle,CSA,FCSA and FI in SC all changed significantly.The paraspinal muscle on the left side and right side were compared post-operatively.At C3/4 level,CSA and FI in paraspinal muscle are significantly larger on the right side.At C4/5 level,FI of SC was significantly larger on the left side.At C5/6 level,CSA and FCSA of paraspinal muscle was significantly larger on the right side.At C6/7 level,FI of paraspinal muscle was significantly larger on the left side.Conclusions:In patients with cervical OPLL,posterior laminoplasty will significantly decrease the CSA and FCSA of paraspinal muscle and increase the FI.Laminoplasty with preservation of unilateral muscular-ligamentous complex will effectively prevent the decrease of muscle volume and increase of fatty infiltration in the preserved side.