棘突悬吊式椎管扩大成形术治疗K线阴性颈椎后纵韧带骨化症的远期疗效

Long-term Curative Effect of Spinous Process Suspension Expansive Laminoplasty for Treatment of K-line Negative Cervical Ossification of Posterior Longitudinal Ligament

目的观察棘突悬吊式椎管扩大成形术治疗K线阴性颈椎后纵韧带骨化症(OPLL)的远期疗效。方法回顾性分析2014年1月至2016年12月在哈尔滨医科大学附属第二医院脊柱外科接受颈后路棘突悬吊式椎管扩大成形术治疗的101例颈椎后纵韧带骨化患者的临床资料,根据术前侧位X线片分为K线阴性组(36例)和K线阳性组(65例)。测量术前及末次随访时颈椎曲度指标[Cobb角、C_(2)~C_(7)矢状面轴向距离(SVA)、T_(1)倾斜角]、C_(2)~C_(7)脊髓矢径和椎管矢径。记录术前及末次随访时日本矫形外科协会(JOA)评分。结果①术前与末次随访时Cobb角、SVA、T_(1)倾斜角的主效应差异无统计学意义(P>0.05),两组间Cobb角的主效应差异有统计学意义(P<0.05),SVA、T_(1)倾斜角的主效应差异无统计学意义(P>0.05),上述各指标的时点间与组间不存在交互作用(P>0.05)。两组间JOA评分的主效应差异有统计学意义(P<0.05),末次随访时两组JOA评分均有显著提高。②K线阳性组末次随访JOA评分改善率优于K线阴性组[83.3(68.5,100.0)%比75.7(50.0,90.0)%](P<0.05),两组末次随访时Cobb差值、SVA差值、T_(1)倾斜角差值比较差异无统计学意义(P>0.05)。③术前及末次随访时C_(2)~C_(7)脊髓矢径的主效应差异有统计学意义(P<0.05),末次随访时所有节段脊髓矢径均较术前增加(P<0.05);两组间C_(2)~C_(3)脊髓矢径的主效应差异有统计学意义(P<0.05),K线阳性组C_(2)、C_(3)节段改善明显优于K线阴性组;C 6~C_(7)脊髓矢径的时点间与组间存在交互作用(P<0.05),K线阳性组变化更明显。④术前及末次随访时C_(2)~C_(7)椎管矢径的主效应差异有统计学意义(P<0.05),末次随访时,两组患者C_(2)~C_(7)椎管矢径均较术前增加(P<0.05)。⑤两组末次随访C_(2)~C_(7)脊髓后移距离和椎管矢径扩大率比较差异无统计学意义(P>0.05),K线阳性组C 6脊髓膨胀程度高于K线阴性组(P<0.05)。结论颈后路棘突悬吊式颈椎管扩大成形术能够有效保持颈椎的曲度和稳定性,可以安全有效扩大椎管矢径,使受压脊髓充分减压,为受压脊髓提供康复条件,并可显著改善K线阳性及无明显颈椎后凸的K线阴性颈椎OPLL患者的JOA评分,远期疗效良好。

Objective To observe the long-term effect of spinous process suspension expansive laminoplasty in patients with K-line negative cervical ossification of the posterior longitudinal ligament(OPLL).Methods A retrospective analysis of the clinical data of 101 patients who underwent posterior cervical spinous process suspension expansive laminoplasty in the treatment of cervical OPLL at Harbin Medical University Spine Surgery from Jan.2014 to Dec.2016 was done.According to the preoperative lateral X-rays,the patients were divided into a K-line negative group(36 cases)and a K-line positive group(65 cases).The cervical spine curvature indexes[Cobb angle,C_(2)-C_(7) sagittal vertical axis(SVA),T_(1) tilt angle],C_(2)-C_(7) spinal cord sagittal diameter and spinal canal sagittal diameter were measured.The preoperative and final follow-up Japanese Orthopedic Association(JOA)scores were recorded.Results①There were no statistically significant differences in the main effects of Cobb angle,SVA and T_(1) tilt angle between preoperative and last follow-up measure(P>0.05);there was significant difference in the main effects of Cobb angle between the two groups(P<0.05);there was no significant difference in the main effects of SVA and T_(1) tilt angle between the two groups(P>0.05),and there was no interaction in the above indicators between the time points and the groups(P>0.05).The main effect difference of JOA scores between the two groups was statistically significant(P<0.05),as at the last follow-up the JOA scores were significantly improved in both groups.②The improvement rate of JOA score at the last follow-up of the K-line positive group was better than that of the K-line negative group[83.3(68.5,100.0)%vs 75.7(50.0,90.0)%](P<0.05),there were no statistically significant differences in Cobb,SVA and T_(1) tilt angle between the two groups at the last follow-up(P>0.05).③The difference between the main effect of C_(2)-C_(7) spinal cord sagittal diameter before operation and the last follow-up was statistically significant(P<0.05).At the last follow-up,all spinal cord sagittal diameters were increased compared with that before operation(P<0.05);the difference in the main effect of C_(2)-C 3 spinal cord diameter between the two groups was statistically significant(P<0.05).The improvement of C_(2) and C_(3) segments in the K-line positive group was significantly better than that of the K-line negative group;there was an interaction in C_(6)-C_(7) spinal cord sagittal diameter between time points and groups(P<0.05),the change of K-line positive group was more obvious.④There was a statistically significant difference between the main effect of C_(2)-C_(7) spinal cord sagittal diameter before operation and at the last follow-up(P<0.05).At the last follow-up,the C_(2)-C_(7) spinal cord sagittal diameters of both groups increased than before operation(P<0.05).⑤There was no significant difference in the C_(2)-C_(7) spinal cord retraction distance and the spinal sagittal diameter expansion rate between the two groups at the last follow-up(P>0.05),the degree of expansion of the C 6 spinal cord in the K-line positive group was higher than that of the K-line negative group(P<0.05).Conclusion Posterior cervical spinous process suspension expansive laminoplasty can effectively maintain the curvature and stability of the cervical spine,and can safely and effectively expand the sagittal diameter of the spinal canal,so that the compressed spinal cord can be fully decompressed for recovery.It can significantly improve the JOA score of the K-line positive cervical OPLL patients,and the non-kyphotic K-line negative patients,and the long-term effect is good.