棘突纵割双开门椎管扩大成形术治疗多节段重度颈椎后纵韧带骨化症的长期疗效

Long-term efficacy of spinous process splitting laminoplasty using coralline hydroxyapatite for severe multisegmental cervical ossification of the posterior longitudinal ligament

目的:探讨棘突纵割双开门椎管扩大成形术(SLAC)治疗多节段重度颈椎后纵韧带骨化症(OPLL)的长期疗效。方法:回顾性分析2005年5月至2011年7月行SLAC的47例多节段重度颈椎OPLL患者的临床资料,其中男25例,女22例,年龄37~72岁,平均(51.1±14.5)岁。20例患者椎管占位率<60%(压迫组),27例患者椎管占位率≥60%(重度压迫组)。手术前后采用颈椎改良日本骨科学会(mJOA)评分、颈椎功能障碍指数(NDI)评估患者神经功能,并进行影像学检查,同时观察并发症发生情况。结果:47例患者随访108~182个月,平均(131.5±24.1)个月。与术前相比,术后神经功能恢复最佳时颈椎mJOA评分增加(3.6±2.4)分,NDI降低(4.8±7.3)%;与术后神经功能恢复最佳时相比,末次随访时颈椎mJOA评分降低(0.6±2.1)分,NDI增加(0.8±2.7)%。术后神经功能恢复最佳时,重度压迫组患者颈椎mJOA评分改善62.5%,与压迫组的64.2%相当(P=0.757)。末次随访时,颈椎前凸角(CL)由术前的14.4°±10.2°下降至12.1°±11.6°,但差异无统计学意义(P=0.087)。压迫组与重度压迫组患者术后并发症发生率差异均无统计学意义(P均>0.05)。结论:SLAC能够有效改善多节段重度颈椎OPLL患者的神经功能,并长期维持疗效和颈椎曲度。对于重度压迫的患者能够获得同样满意的疗效。

Objective:To investigate the long-term clinical efficacy of spinous process splitting laminoplasty using coralline hydroxyapatite(SLAC)in the treatment of multisegmental severe cervical ossification of the posterior longitudinal ligament(OPLL).Methods:Clinical data of 47 patients with severe multisegmental cervical OPLL who underwent SLAC between May 2005 and July 2011 were retrospectively analyzed.There were 25 males and 22 females,aged 37 to 72 years,with an average age of(51.1±14.5)years.Twenty patients with a spinal canal occupying ratio<60%were included into the compression group,and 27 patients with an occupying ratio≥60%were included in the severe compression group.Neurological function was evaluated using the modified Japanese Orthopedic Association(mJOA)score and the neck disability index(NDI)both preoperatively and postoperatively,and imaging examinations were performed to observe the complications.Results:Forty-seven patients were followed up for 108-182 months,with an average of(131.5±24.1)months.Compared to the preoperative scores,the mJOA score increased by(3.6±2.4)points at the time of optimal neurological recovery postoperatively,and the NDI decreased by(4.8±7.3)%.At the last follow-up,compared to the time of optimal neurological recovery,the mJOA score decreased by(0.6±2.1)points,and the NDI increased by(0.8±2.7)%.At the time of optimal neurological recovery postoperatively,the improvement in mJOA score was 62.5%in the severe compression group,which was comparable to the 64.2%in the compression group(P=0.757).At the last follow-up,the cervical lordosis angle decreased from 14.4°±10.2°preoperatively to 12.1°±11.6°,but the difference was not statistically significant(P=0.087).There was no statistically significant difference in the incidence of postoperative complications between the two groups(all P>0.05).Conclusions:SLAC can effectively improve neurological function in patients with multisegmental severe cervical OPLL and maintain long-term efficacy and cervical lordosis.Comparable satisfactory outcomes can be achieved in patients with severe compression.