颈椎单开门椎管扩大椎板成形悬吊固定与微型钛板固定治疗颈椎后纵韧带骨化症的长期疗效

Long-term outcomes of suspension fixation vs miniature titanium plate fixation for laminoplasty in cervical ossification of the posterior longitudinal ligament

目的:对比分析颈椎后路单开门椎管扩大椎板成形悬吊固定与微型钛板固定治疗颈椎后纵韧带骨化症(ossification of the posterior longitudinal ligament,OPLL)的长期疗效。方法:2006年1月~2011年12月在我院行单开门椎管扩大椎板成形术的173例颈椎OPLL患者作为研究对象,根据固定方式不同分为两组:采用悬吊固定的患者为A组,共76例,其中男44例,女32例,年龄59.8±8.9岁,病程112.7±4.8个月,术前JOA评分为10.5±1.0分,术前颈椎活动度(ROM)为40.6°±1.6°,椎管矢状径为15.5±2.5mm,随访时间83.2±8.8个月;采用微型钛板固定的患者为B组,共97例,其中男58例,女39例,年龄61.9±6.0岁,病程113.1±4.1个月,术前JOA评分为11.5±1.9分,颈椎ROM为41.8°±3.6°,椎管矢状径为16.3±3.0mm,随访时间81.2±9.8个月。术前患者均存在不同程度的四肢肌力减退、步态不稳、双下肢肌张力增高、病理征阳性等髓性症状和体征。记录两组患者的手术时间、术中出血量、平均住院费用、术后并发症发生情况,末次随访时对患者进行JOA评分,测量颈椎ROM和椎管矢状径,计算末次随访时JOA评分改善率、颈椎ROM丢失和椎管矢状径改善率。结果:两组患者年龄、性别比、病程、术前JOA评分、颈椎ROM、椎管矢状径和随访时间均无显著性差异(P>0.05)。A组术中出血量为215±20ml,手术时间为1.7±0.6h,平均住院费用为5.6±0.8万元,术后4例发生C5神经根麻痹,8例发生轴性痛,1例再关门;B组术中出血量217±17ml,手术时间为1.8±0.5h,平均住院费用为7.8±1.4万元,术后7例发生C5神经根麻痹,10例发生轴性痛。两组术中出血量、手术时间和术后并发症发生率无统计学差异(P>0.05),A组平均住院费用显著性低于B组(P<0.01)。末次随访时A组JOA评分改善率为(53.23±13.76)%,B组为(54.22±14.11)%,差异无统计学意义(P>0.05);A组颈椎ROM丢失8.3°±5.2°,B组为12.1°±6.6°,差异有统计学意义(P<0.05);A组椎管矢状径改善率为(28.89±4.33)%,B组为(37.74±3.71)%,差异有统计学意义(P<0.05)。结论:采用微型钛板固定和丝线悬吊固定的颈后路单开门椎管扩大椎板成形术治疗颈椎OPLL均可达到满意的长期疗效。钛板固定可以更好地维持椎管矢状径的良好状态;悬吊固定在术后长期颈椎ROM保留方面有一定优势,且住院费用更低。

Objectives:To compare the long-term outcomes of suspension fixation and miniature titanium plate fixation in cervical ossification of the posterior longitudinal ligament(OPLL).Methods:A total of 173 patients with OPLL who underwent operation from January 2006 to December 2011 were reviewed.The patients were divided into two groups according to different fixation methods.Group A contained 76 cases(44 males and 32 females)who were suspended by silk thread,and group B contained 97 cases(58 males and 39 females)who were fixed by miniature titanium plate.The mean age and follow-up time in group A and group B were 59.8±8.9 years and 83.2±8.8 months,61.9±6.0 years and 81.2±9.8 months respectively.There was no statistically significant difference of preoperative baseline data such as JOA score,cervical range of motion,and sagittal diameter of spinal canal between the two groups.Preoperative symptoms of cervical spondylotic myelopathy were found in both groups,such as decreased limb strength,unstable walking,and increased muscle tension.We recorded the average operative time,intraoperative blood loss,postoperative complications,and total expense of hospitalization.The followings were acquired at the last follow-up:JOA score,improvements in ROM and sagittal diameter of spinal canal.Results:There was no statistically significant difference of preoperative baseline data between the two groups(P>0.05).In group A,the intraoperative blood loss was 215±20ml,the average operation time was 1.7±0.6h,and the average hospitalization cost was 5.6±0.8(10,000 yuan).There were 4 cases of C5 palsy,8 cases of axial pain and 1 case of close door after surgery.In group B,the above indexes were 217±17ml,1.8±0.5h and 7.8±1.4(10,000 yuan),respectively.There were 7 cases of C5 palsy and 10 cases of axial pain.These complications disappeared within 1 month after systematic conservative treatment.There was no statistically significant difference of operative time,intraoperative blood loss,postoperative complications and JOA improvement rate between the two groups(P>0.05).However,the hospitalization cost of suspension fixation was significantly lower than that of microtitanium plate fixation(P<0.01).Meanwhile,ROM loss in group A was 8.3°±5.2°,which was lower than 12.1°±6.6°in group B.At the last follow-up,the improvement rate of sagittal diameter in group B was(37.74±3.71)%,which was higher than that in group A[(28.89±4.33)%,P<0.05].Conclusion:Both wire suspension and micro-titanium plate fixations can achieve satisfactory long-term outcomes in OPLL.Suspension fixation was associated with better maintenance of cervical range of motion and lower hospitalization costs,while micro-titanium plate fixation obtains better maintenance of sagittal diameter of spinal canal.