显微镜辅助下颈前路ACDF联合高速磨钻治疗孤立型颈椎后纵韧带骨化症的临床研究

Clinical study on treatment of isolated ossification of posterior longitudinal ligament of cervical spine with ACDF assisted by microscope combined with high-speed grinding and drilling

目的观察显微镜辅助下颈椎前路椎间盘切除融合内固定术(anterior cervical discectomy and fusion,ACDF)联合高速磨钻治疗孤立型颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)的临床疗效及有效性。方法回顾性分析2018年1月~2020年12月本院骨科诊治的孤立型后纵韧带骨化症患者28例,均在显微镜辅助下联合高速磨钻行颈椎前路ACDF手术,其中男13例,女15例;年龄40~65岁;C_(3-4)3例,C_(4-5)8例,C_(5-6)7例,C_(6-7)10例。对患者术前及术后1年进行相关指标评价,同时观察患者术后出现的相关并发症。结果所有患者均获得随访,术后1年JOA评分、NDI评分、颈椎VAS评分均较术前显著改善,差异有统计学意义(P<0.05)。3例患者因后纵韧带骨化和硬膜黏连严重,用超声骨刀将其打薄后漂浮,未行彻底切除。术后患者未出现喉返神经、喉上神经损伤,无脊髓损伤及脑脊液漏。结论显微镜辅助下ACDF联合高速磨钻治疗孤立型后纵韧带骨化症,可较好地改善患者神经功能,取得较好的临床疗效,术中操作安全性高。

Objective To observe the clinical efficacy and effectiveness of anterior cervical discectomy and fusion(ACDF)combined with high-speed grinding and drilling in the treatment of isolated ossification of posterior longitudinal ligament(OPLL)by means of microscope assisted surgery.Methods A retrospective analysis was performed on the clinical data of 28 patients withOPLLtreated in the OrthopedicDepartment of our hospitalfrom January 2018 to December 2020,and the patientsallreceived anterior cervial ACDFwith high-speedgrinding drill,including13 cases of men and 15 casesof women,aged from 40~65 years;there were 3 cased of C_(3-4),8 cases of C_(4-5),7 cases of C_(5-6),and 10 cases of C_(6-7).The relevant indicators of patients before and 1 year after surgerywere evaluated,and the related postoperative complications were observed.Results All patients were followed up,and the JOA score,NDI score and cervical VAS score were improved one year after surgery,with statistically significant differences(P<0.05).Due to ossification of the posterior longitudinal ligament and severe dural adhesion,3 patients were thinned and floated with an ultrasonic osteotomy knife,but complete resection was not performed.There was no injury of recurrent laryngeal nerve,superior laryngeal nerve,spinal cord injury and cerebrospinal fluid leakage.Conclusion Microscope-assisted ACDF combined with high-speed grinding and drilling in the treatment of OPLL can better improve the neurological function of patients,achieve good clinical efficacy,and improve the safety of operation.