颈椎后纵韧带骨化与椎间盘突出合并无骨折脱位颈脊髓损伤的手术疗效比较

Comparative study on the surgical effect of cervical OPLL and intervertebral disc herniation combined with cervical spinal cord injury without fracture and dislocation

目的 :探讨颈椎后纵韧带骨化(ossification of posterior longitudinal ligament,OPLL)或颈椎间盘突出合并无骨折脱位颈脊髓损伤患者手术治疗的效果及其差异性。方法:回顾性分析2017年1月~2019年12月我科收治的无骨折脱位颈脊髓损伤并经手术治疗患者,选取其中35例3个节段及以上OPLL或者颈椎间盘突出患者纳入本研究。其中男性19例,女性16例。根据术前MRI及CT影像学特点将患者分为OPLL组(A组18例)与颈椎间盘突出组(B组17例),两组间年龄及性别无统计学差异(P>0.05)。手术方式均为颈椎后路椎管扩大成形术。记录两组患者术前及术后1周、3个月、6个月的mJOA评分及ASIA分级,计算并比较mJOA评分改善率和ASIA分级改善值。结果:A组手术时间为95±12min,B组为95±15min (P>0.05);A组术中出血量为450±55ml,B组为440±60ml(P>0.05);A组住院时间为10.5±1.3d,B组为10.2±1.4d(P>0.05)。随访期间两组患者均未出现严重并发症。A组术前、术后1周、术后3个月、术后6个月mJOA评分分别为5.2±5.6分、7.1±4.3分、8.6±3.7分、12.9±3.8分,B组分别为4.8±3.8分、6.7±4.1分、7.0±3.8分、9.3±3.6分,两组间差异无统计学意义(P>0.05)。术后1周两组mJOA评分改善率分别为16.2%和14.1%,ASIA分级改善值分别为1.2分和1.0分,两组间无统计学差异(P>0.05);术后3个月mJOA评分改善率分别为26.5%和16.5%,ASIA分级改善值分别为2.3分和1.5分,两组间有统计学差异(P<0.05);术后6个月mJOA评分改善率分别为62.3%和33.6%,ASIA分级改善值分别为2.6分、1.8分,两组间有统计学差异(P<0.05)。结论:后路椎管扩大成形术治疗无骨折脱位颈脊髓损伤能够获得满意疗效,其中合并OPLL患者神经功能恢复改善程度在术后3个月及术后6个月时优于合并颈椎间盘突出患者,该差异可能与脊髓致压物的性质有一定关系。

Objectives: To investigate the clinical characteristics and surgical effects of ossification of posteri-or longitudinal ligament(OPLL) of cervical spine and disc herniation combined with spinal cord injury without fracture and dislocation. Methods: Retrospective analysis of patients with cervical spinal cord injury without fracture and dislocation treated with posterior laminoplasty in our department from January 2017 to December 2019, 35 patients with cervical spinal cord injury without fracture and dislocation who were treated surgically were selected for this study. There were 19 males and 16 females. According to the imaging characteristics by MRI and CT, the patients were divided into cervical posterior longitudinal ligament ossification group(group A, 18 cases) and cervical disc herniation group(group B, 17 cases). The mJOA score and itsimprove-ment rate, as well as the ASIA score and ASIA score improvement value were recorded before operation, at 1 week, 3 months, and 6 months after operation. Results: In group A and group B respectively, the operation time was 95±12min and 95±15min, the intraoperative blood loss was 450±55ml and 440±60ml, and the length of hospital stay was 10.5±1.3d and 10.2±1.4d. The follow-up time nodes were 1 week, 3 months and more than 6 months after operation. There were no serious complications in both groups. At pre-operation, 1 week,3 months, and 6 months after operation, the mJOA scores of group A were 5.2 ±5.6, 7.1±4.3, 8.6±3.7, and 12.9±3.8 respectively, and those in group B were 4.8±3.8, 6.7±4.1, 7.0±3.8, and 9.3±3.6 respectively. There was no significant difference between the two groups(P>0.05). One week after operation, the mJOA scores were 7.1±4.3 in group A and 6.7±4.1 in group B, and the improvement rates of mJOA scoreswere 16.2% and 14.1% respectively, and the improvement values of ASIA were 1.2 and 1.0 respectively. There was no significant difference between the two groups(P>0.05). At 3 months after operation, the mJOA scores of group A and group B were 8.6±3.7 and 7.0±3.8, and the improvement rates of mJOA scores were 26.5% and 16.5% respectively, and the improvement values of ASIA were 2.3 and 1.5 respectively. There was significant difference between the two groups(P<0.05). At 6 months after operation, the mJOA scores of group A and group B were 12.9±3.8 and 9.3±3.6 respectively. The improvement rates of mJOA scores were 62.3% and 33.6% respectively, and the improvement values of ASIA scores were 2.6 and 1.8 respectively. There was significant difference between the two groups(P<0.05). Conclusion: Posterior laminoplasty can achieve satisfactory results in the treatment of cervical spinal cord injury without fracture and dislocation. The improvement of neurological recovery in patients with cervical spinal cord injury combined with ossification of cervical posterior longitudinal ligament is better than that patients who combined with cervical disc herniation at 3 and 6 months after operation.