3种不同手术方式治疗颈椎后纵韧带骨化症的疗效对比研究

A Comparative Study of Three Different Surgical Methods in the Treatment of Ossification of Posterior Longitudinal ligament of Cervical Spine

目的:分析3种手术方式治疗颈椎后纵韧带骨化症的疗效及经济效益。方法:收集自2011年1月-2016年12月在韶关市第一人民医院脊柱科行颈椎手术的颈椎后纵韧带骨化症患者资料67例,其中女性39例,男性28例,年龄46-78岁,平均56.4岁,病程10个月-22年,平均3.8年。根据手术方式分为3组:颈椎前路减压植骨融合内固定术31例(A组);后路组:颈椎后路单开门椎管扩大成形术29例(B组);后前路联合入路组:先行后路单开门椎管扩大成形术,再1期行前路减压植骨融合内固定术7例(C组)。统计3种不同手术方式患者的术前脊髓压迫率、手术时间、术中出血量、并发症、住院总费用、术前、术后、随访时JOA评分、随访时JOA评分改善率、脊髓膨胀程度,对数据进行统计分析。结果:C组术前脊髓压迫率最大(平均为39.6%),A组与B组无明显差别(P>0.05);C组的手术时间及术中出血量均大于A组及B组,A组与B组无明显差别(P>0.05);A组1例出现钛笼塌陷,1例出现颈肩部疼痛,1例出现脑脊液漏,B组2例出现颈5神经根麻痹,C组出现2例颈部轴性症状;住院总费用C组>B组>A组,差异有统计学意义(P<0.05)。术后及随访时JOA评分与术前比较均有统计学意义(P<0.05),术后随访时JOA评分改善率3组之间有统计学意义,C组>A组、B组(P<0.05),术后脊髓膨胀程度3组之间有统计学意义,C组>A组、B组(P<0.05),但A组与B组比较均无明显差别。结论:3种手术方式均能有效治疗颈椎后纵韧带骨化症,手术入路的选择需根据患者后纵韧带骨化的具体情况来选择;若3种方式均可选择,从住院费用方面考虑,优先选择行前路减压融合手术。

Objective:To analyze the curative effect and economic benefit of three methods for the treatment of ossification of posterior longitudinal ligament(OPLL)of cervical spine.Methods:The clinical data of 67 patients from January 2011 to December 2016 with cervical OPLL who underwent cervical surgery in the department of spine of the first peoples hospital of Shaoguan city were reviewed and analyzed,39 cases were female and 28 cases were male,aged from46 to 78 years,with an average of 56.4 years,from October to 22 years and an average of 3.8 years.The patients were divided into three groups according to the surgical Methods:31 patients(Group A)experienced anterior cervical decompression and fusion for direct dessect of the ossified ligament,29 patients(Group B)experienced posterior unilateral open-door laminoplasty,and 7 patients(Group C)experienced one stage combined anterior and posterior operation(posterior unilateral laminoplasty followed by anterior cervical decompression and fusion).The preoperative spinal cord compression rate,operation time,intraoperative bleeding volume,complication,total hospital expenses,preoperative,postoperative follow-up JOA score,improvement rate of JOA score,improvement rate of JOA score at follow-up,and extent of spinal cord expansion in patients with three different surgical methods were observed in this study,the data were analyzed statistically.Results The rate of spinal cord compression was the largest in group C(mean 39.6%),and there was no significant difference between group A and group B(P>0.05).The time of operation and the amount of intraoperative bleeding in group C were higher than those in group A and groupB(P<0.05),and there was no signif-icant difference between group A and group B(P>0.05).One cases of titanium mesh subsidence,one cases with the pain of neck-shoulder in Group A,two cases of C5 palsy in Group B,two cases of axial pain in Group C.Total hospitalization costs in group C>group B>group A,the difference was satistially significant(P<0.05).The JOA score was statistically significant compared with the preoperative score during postoperative and follow-up(P<0.05),and the improvement rate of JOA score was statistically significant among the three groups during postoperative and follow-up,group C>group A and group B(P<0.05).There was statistical significance in the degree of the extent of spinal cord expansion among the three groups,group C>group A and group B(P<0.05),but there was no significant difference between group A and group B.Conclusions:Three kinds of operation methods can treat OPLL of cervical spine ffectively,the choice of surgical approach should depend on the characteristics of patients;if the three methods can be selected,considering the cost of hospitalization,the preferred choice of anterior decompression fusion surgery.