颈椎后路两种手术方式治疗多节段颈椎后纵韧带骨化症的疗效分析

Analysis of efficacy of two posterior laminoplasty and laminectomy in treatment of cervical ossification of posterior longitudinal ligament

目的观察对比在后路椎板切除减压融合内固定术和后路椎管成形术治疗OPLL术后临床疗效。方法2012年9月至2017年12月,采用椎板切除减压融合术治疗82例,采用后路椎管成形术治疗132例。椎板切除减压融合组82例行椎板切除减压融合侧块螺钉内固定术;椎管成形术组132例行单开门椎管成形术。全部214例患者术后获得24个月的随访,平均(36±8)个月;通过采用疼痛视觉模拟评分法(VAS)比较2组患者术前、术后24个月随访疼痛程度;采用日本骨科学会评分(JOA)评估患者术前及术后24个月随访时神经功能恢复情况;并通过测量患者术前、术后24个月随访时的颈椎正侧位及过伸过屈位X线计算颈椎曲度指数(CCI)、颈椎矢状位平衡指数(C2~7 Sagittal Vertical Axis,C2~7SVA)及颈椎活动度(ROM)。结果2组术后24个月随访JOA评分及VAS评分较术前均明显改善(P<0.05),但2组间术后JOA评分及VAS评分差异无统计学意义(P>0.05)。2组术后24个月随访ROM均较术前丢失(P<0.05),但椎板切除减压融合组ROM丢失度比椎管成形组大(P<0.05)。24个月随访时,2组患者CCI与术前比较显著降低,椎管成形组患者CCI低于椎板切除减压融合组(P<0.05),2组患者CCI丢失量比较差异无统计学意义(P>0.05);2组患者C2-7SVA与术前比较显著增加(P<0.05),椎管成形组患者C2~7SVA高于椎板切除减压融合组(P<0.05),椎管成形组患者C2-7SVA增加值高于椎板切除减压融合组(P<0.05)。椎板切除减压融合组术后轴性症状1例,C5神经根麻痹2例;椎管成形术组术后轴性症状3例,C5神经根麻痹4例;椎板切除减压融合组术后轴性症状、C5神经根麻痹及并发症总发生率低于椎管成形组,差异有统计学意义(P<0.05)。结论颈椎后路椎板切除减压融合术与颈椎后路椎管成形术治疗多节段颈椎OPLL,在临床神经功能改善,颈椎曲度改善等方面均能获得良好的效果;尽管颈椎后路椎板切除减压融合术在颈椎活动度保留方面不如颈椎椎板成形术,但在维持颈椎曲度、矢状位平衡方面优于椎管成形术,并可以进行术后早期康复锻炼,提高生活质量,疗效确切。

Objective To explore the clinical efficacy of posterior cervical single-door laminoplasty and laminectomy with decompression and fusion for the treatment of multi-segment of posterior longitudinal ligament ossification cervical spine. Methods Clinical data of two kinds of surgeries for the ossification of multi-segmental posterior longitudinal ligsment of cervical spine in the several central hospital from September 2012 to December 2017,including82 patients who underwent total lamonectomy with decompression and fusion and 132 patients who underwent lamin-oplasty. Among them,82 patients in the laminectomy decompression and fusion group received total laminectomy with decompressionand fusion,and 132 patients in the single door group received single-door laminoplasty. After 24 months of follow-upuith with the average of(36 ±8) g months. The cervical curvature index(CCI),Cervical 2 to 7 vertebral bodies Sagittal Vertical Axis(C2-7 Sagittal Vertical Axis,C2-7 SVA)and the range of motion of cervical spine(ROM)were calculated by measuring the cervical lateral position and over extension and flexion X-ray at the time of preoperative and postoperative follow-up,Calculate postoperative incision infection,cerebrospinal fluid leakage,axial symptoms,and incidence of C5 nerve root palsy. Results The postoperative JOA score and VAS score of the two groups were significantly improved compared with those before the operation(P <0.05),while the postoperative JOA 5 score and VAS score of the two groups were not significantly different(P>0.05). The cervical vertebral activity(ROM) of the 24 months followup visit after sur-gery in both groups was higher than that before surgery(P <0.05),but the cervical range of motion(ROM)of the laminar de-compression and fusion group was higher than that of the single-door group(P<0.05). At the 24 monthst follow-up,the CCI of the two groups was significantly lower. The CCI of the laminoplasty group was lower than the laminectomy decom-pression and fusion group(P<0.05),There was no significant difference in CCI loss between the two groups(P>0.05);At the 24 month′s follow-up,the C2-7 SVA of the laminoplasty group was higher than the laminectomy decompression and fusion group(P<0.05). The increase of C2-7 SVA in the laminoplasty group was higher than that in the laminectomy decompression and fusion guoup. In the laminoplasty decompression and fusion group,1 case had axial symptoms,2 cases had C5 nerve root palsy. In the laminoplasty group,axial symptoms were observed in 3 cases and C5 nerve root palsy in 4 cases. The total incidence of postoperative axial symptom C5 nerve root paralysis and complications in the laminectomy decompression and fusion guoup was lower than that in the laminoplasty group,and the difference was statistically significant(P<0.05). Conclusion Laminectomy decompression and fussion and laminoplasty for the treatment of OPLL can achieve satisfying clinical effect. Laminoplasty have greater mobility after surgery than lamibectomy decompression and fusion,but laminectomy is better than laminoplasty in maintaining cervical curvature and sagittal position,and lower complication rate.