颈椎前路经骨化带铰链式截骨前凸重建并后路椎管成形术:初步临床报告

Anterior cervical hinge-like osteotomy through ossification ligament to reconstruct cervical lordosis combined with posterior laminoplasty:preliminary clinical report

目的探讨一种颈椎前路经骨化带铰链式截骨前凸重建并后路椎管成形术治疗K线阴性的连续性颈椎后纵韧带骨化症(OPLL)的方法。方法对1例颈椎前凸消失、K线阴性、累及C2~C5的多节段连续性OPLL患者,首先采取后路C3~C5单开门椎管扩大成形术,同时行C2/3、C3/4、C4/5侧块关节V形截骨和松解;然后经前路C2/3、C3/4、C4/5间隙以超声骨刀将连续的骨化物截断成铰链状,借助钛板将含骨化物的颈椎椎体铰链式前移,重建颈椎前凸,实现前路减压。记录手术时间和术中出血量,术后复查颈椎X线片、CT、MRI,观察颈椎椎管扩大程度及脊髓压迫、颈椎前凸改善情况,采用日本骨科学会(JOA)评分评估脊髓功能恢复情况。结果术程顺利,手术时间4 h,出血量400 mL。患者胸背部束带感术后即刻消失,四肢肌力改善。术后1周复查CT示颈椎椎管较术前明显扩大,颈椎前凸改善;颈椎MRI示颈脊髓压迫解除。结论在后路单开门手术的基础上采用颈椎前路经骨化带铰链式截骨前凸重建技术,为治疗复杂OPLL提供一种新的方法;该术式可以重建颈椎前凸,减压理想,初步临床效果满意。

Objective To investigate a surgical procedure of anterior cervical hinge-like osteotomy through ossification ligament to reconstruct cervical lordosis combined with posterior laminoplasty for treating continual cervical ossification of posterior longitudinal ligament(OPLL)with negative K line.Methods A patient diagnosed as continual multilevel OPLL involved C2 to C5 with disappearance of cervical lordosis and negative K line was treated according to the following procedures:posterior expansive single open-door laminoplasty for C3 to C5 was performed firstly,combined with V-type osteotomy and lateral mass joints release of C2/3,C3/4 and C4/5,then the procedure was changed to anterior approach,the osteotomy through continual cervical ossification in C2/3,C3/4 and C4/5 intervertebral space was performed to form a hinge-like structure by ultrasound scalpel,then a titanium plate was used to push the cervical vertebrae-ossification compound anteriorly,then to reconstruct the cervical lordosis and achieve anterior decompression.Operation time and estimate intraoperative blood loss were recorded.Cervical X-ray,CT and MRI were examined to evaluate the enlargement of spinal cannal as well as the improvement of spinal cord compression and cervical lordosis.Spinal function was evaluated by Japanese Orthopaedic Association(JOA)score.Results The procedure was completed successfully,with the operation time of 4 h and the estimate intraoperative blood loss of 400 mL.Thoracic banding sensation disappeared instantly after surgery,and the improvement of muscle strength in extremities was found.At 7 d after the surgery,CT and MRI showed that the spinal cannal was enlarged significantly,cervical lordosis was improved,and cervical cord compression relieved.Conculsion Based on posterior single open-door laminoplasty,application of anterior cervical hinge-like osteotomy through ossification ligament to reconstrut cervical lordosis can provide a novel method for treating complex OPLL,which can reconstruct the cervical lordosis,obtain good decompression and achieve satisfactory preliminary clinical efficacy.