颈后纵韧带骨化伴颈椎过伸性损伤的手术治疗

目的观察颈椎前路植骨融合内固定及后路单开门椎管成形术治疗合并后纵韧带骨化的颈椎过伸性损伤的疗效。方法2016年3月至2020年10月收治合并颈后纵韧带骨化的颈椎过伸性损伤患者60例,其中男49例,女11例;年龄45~83岁,中位年龄64岁。合并发育性椎管狭窄10例、黄韧带骨化8例。采用颈椎前路植骨融合内固定手术治疗50例及后路单开门椎管成形手术治疗10例。分别于术前及术后3个月使用ASIA评分评价神经功能,观察脑脊液漏、喉返神经损伤、C5神经麻痹及颈部轴性症状等并发症,拍摄X线片观察术后颈椎屈曲指数变化。结果60例患者均获随访,随访时间8~36个月,中位数15个月。均未出现门轴断裂及再关门现象,前后路内固定稳定,未出现松动失效。有1例脑脊液漏,无喉返神经及C5神经根麻痹症状,2例出现颈部轴性症状,经康复锻炼等对症治疗后症状基本恢复。两组术后ASIA评分比术前改善(P<0.05),前路评分值比后路改善(P<0.05),两组术后颈椎屈曲指数差异无统计学意义(P>0.05)。结论采用颈椎前路及后路手术治疗合并后纵韧带骨化的颈椎过伸性损伤,均能有效维持脊椎稳定,使椎管彻底减压,脊髓神经恢复良好,但前路效果优良,应首选前路手术,而对于多节段骨化椎管狭窄的后路手术亦是有效的替代方式。

Objective To observe the clinical eficacy of anterior cervical internal fixation and posterior open-door laminoplasty in the treatment of cervical hyperextension injury complicated with ossification of posterior longitudinal ligament.Methods From March 2016 to October 2020,60 patients with cervical hyperextension injury complicated with ossification of the posterior longitudinal ligament were admitted to our hospital,including ll females and 49 males.The ages ranged from 45 to 83,with a median of 64.There were 10 cases with developmental spinal stenosis and 8 cases with ossification of ligamentum flavum.50 cases were treated with anterior cervical fusion and internal fixation,and 10 cases were treated with posterior laminoplasty.The ASIA score was used to evaluate the neurological function before and 3 months after surgery,and the complications such as cerebrospinal fluid leakage,recurrent laryngeal nerve injury,C5 nerve palsy and cervical axial symptoms were observed.X-ray were used to observe the postoperative cervical flexion index.ResultsAll 60 patients werefollowed up for 8~36months,with a median of15months.There was no door shaft fracture and reclosing.The anterior and posterior internal fixation of cervical spine was stable.One case had cerebrospinal fluid leakage,no symptoms of recurrent laryngeal nerve and C5 nerve root paralysis,and two cases had cervical axial symptoms.After symptomatic treatment such as rehabilitation exercise,these symptoms basically recovered.The postoperative ASIA score of the two groups was improved compared with that before operation(P<0.05).The score of anterior approach was better than that of posterior approach(P<0.05).There was no significant difference in postoperative cervical flexion index between the two groups(P>0.05).Conclusion Both anterior and posterior cervical surgery for cervical hyperextension injury with ossification of the posterior longitudinal ligament can effectively maintain spinal stability,completely decompress the spinal canal,and restore the spinal nerves well.However anterior approach should be the first choice,and posterior approach is also an effective alternative for multilevel ossified spinal stenosis.