对延伸至上颈椎单开门椎管扩大成形术治疗上颈椎后纵韧带骨化症的长期随访

A long-term follow-up of the treatment of ossification of the posterior longitudinal ligament by C1,2 single-door laminoplasty

目的 评估延伸至C后路单开门椎管扩大成形术治疗上颈椎后纵韧带骨化症(OPLL)的长期疗效。方法 回顾性分析2011年12月至2012年12月在山西医科大学第二医院骨科使用延伸至C后路单开门椎管扩大成形术的术式治疗的颈椎OPLL患者20例;其中男12例,女8例;年龄44~72(57.1±6.3)岁。应用日本骨科协会(JOA)评分进行神经功能评估。应用颈椎功能障碍指数(NDI)进行生活质量评估。应用视觉模拟评分法(VAS)评估术后轴性症状。在颈椎侧位X线上测量术前及末次随访C角,C角颈椎曲度变化,反应颈椎曲度变化;在颈椎过伸过屈位X线测量ROM来观察颈椎活动度变化。结果 2例患者失访;其余18例均获114~124(119.2±5.1)个月随访。末次随访时,JOA评分为(14.07±2.37)分,NDI评分为(7.46±1.15)分,VAS评分为(1.45±0.62)分,与术前相比差异均有统计学意义。C角术前为(24.96°±6.53°),末次随访为(22.58°±5.96°);C角术前为(18.72°±4.85°),末次随访为(15.73°±5.56°),差异均无统计学意义。术前颈椎活动度及过伸位颈椎活动度变化,差异无统计学意义。过屈位颈椎活动度ROM术前为(10.13°±3.83°),末次随访为(4.65°±3.97°),差异有统计学意义。其中9例中出现OPLL骨化灶进展。结论 分析延伸至C后路单开门椎管扩大成形术治疗上颈椎后纵韧带骨化症的长期临床疗效满意。脊髓减压及神经功能改善满意。颈椎曲度及活动度变化不大,轴性症状无增加。

Objective To evaluate the long-term follow-up data of the clinical effect of the treatment of ossification of the upper cervical posterior longitudinal ligament by Cposterior single door laminoplasty. Methods from December 2011 to December 2012, 20 patients with cervical OPLL treated by Cposterior single door laminoplasty in Department of Orthopaedics, the second hospital of Shanxi Medical University, including 12 males and 8 females;aged 44-72(57.1±6.3)years. The JOAscore was used to evaluate neurological function. The quality of life was evaluated by NDI. VAS was used to evaluate postoperative axial symptoms. The cervical curvature changes of Cangle and Cangle were measured on the lateral X-ray of cervical spine before operation and the last follow-up to reflect the changes of cervical curvature;ROM was measured by X-ray in the hyperextension and flexion position of cervical spine to observe the change of cervical mobility. Results Two patients lost follow-up;the other 18 patients were followed up for 114-124(119.2±5.1)months. At the last follow-up, the JOA score was(14.07±2.37);the NDI score was(7.46±1.15);the VAS score was(1.45±0.62). There were significant differences than those before operation. The preoperative Cangle was(24.96 °±6.53 °);the last follow-up was(22.58 °±5.96 °);Cangle was(18.72 °±4.85 °) before operation, and(15.73 °±5.56 °) at the last follow-up. The angle decreased slightly at the last follow-up;the decrease was similar, which was not statistically significant. There was no significant difference in preoperative cervical mobility and cervical mobility in hyperextension position. The ROM of cervical spine in hyperflexion position was(10.13 °±3.83 °) before operation and(4.65 °±3.97°) during the last follow-up. The difference was statistically significant. OPLL ossification progression occurred in 9 cases. Conclusion The long-term clinical effect of Cposterior single door laminoplasty for upper cervical posterior longitudinal ligament ossification is satisfactory. The decompression of spinal cord and the improvement of neurological function are satisfactory. The curvature and activity of cervical spine change little. The axial symptoms do not increase.