显微镜辅助椎间盘切除融合内固定术对局限型后纵韧带骨化症的疗效研究

Efficacy of microscope-assisted anterior cervical discectomy and fusion as well as internal fixation for the treatment of localized ossification of the posterior longitudinal ligament

目的探析局限型后纵韧带骨化症(OPLL)患者接受显微镜下椎间盘切除融合内固定术(ACDF)治疗的近期与远期疗效情况。方法回顾性选取2020年2月—2022年2月收治的局限型OPLL患者105例,按照ACDF治疗过程中是否辅助使用显微镜分为显微镜组56例和常规组49例,观察围术期指标、视觉模拟评分法(VAS)评分、健康调查评估量表(SF-36)评分、椎管最狭窄处椎管面积与脊髓前后径、颈椎活动度、椎间隙高度、关节功能[日本骨科医师协会评分(JOA)颈椎病评分及颈部障碍指数(NDI)]及并发症风险。结果显微镜组平均手术时间(141.85±18.35)min、平均住院时间(10.18±1.58)d短于常规组的(159.46±21.42)min、(12.03±1.82)d,显微镜组术中平均出血量(80.65±7.28)mL少于常规组的(103.52±10.43)mL,差异有统计学意义(P<0.05);显微镜组术后6个月VAS评分(2.82±0.53)分、SF-36评分(79.56±5.68)分优于常规组的(3.51±0.60)、(72.35±4.77)分,差异有统计学意义(P<0.05);显微镜组与常规组在术后椎管面积、脊髓前后径上比较[(138.24±24.32)mm^(2)与(123.62±18.74)mm^(2),(5.42±0.46)mm与(4.73±0.51)mm],差异有统计学意义(P<0.05);显微镜组与常规组在术后6个月颈椎活动度上比较[(25.21±3.37)°与(28.65±3.56)°],差异有统计学意义(P<0.05);显微镜组并发症发生率为5.36%,低于常规组的18.37%,差异有统计学意义(P<0.05);显微镜组与常规组JOA、NDI评分在时间、组间和交互效应上比较,差异有统计学意义(P<0.05)。结论局限型OPLL患者实施ACDF治疗过程中借助显微镜提供清晰视野,并对骨化灶采用磨钻磨除、打薄处理,能更有效地解除脊髓压迫,改善近期疼痛和关节功能状况,降低脊髓损伤等并发症风险。

Objective To explore the short-term and long-term efficacy of anterior cervical discectomy and fusion(ACDF)under microscopic assistance for patients with focal ossification of the posterior longitudinal ligament(OPLL).Methods A total of 105 patients with focal OPLL treated between February 2020 and February 2022 were retrospectively selected.They were divided into microscope group(n=56)and conventional group(n=49)based on whether ACDF was assisted by microscopy.Perioperative indicators,Visual Analogue Scale(VAS)scores,36-item Short-Form Health Survey(SF-36)scores,spinal canal cross-sectional area at the narrowest point,anteroposterior diameter of the spinal cord,cervical range of motion,intervertebral height,joint function[Japanese Orthopaedic Association(JOA)cervical spine disease score and Neck Disability Index(NDI)],and occurrence of complication were observed.Results The average operative time and average hospital stay in the microscope group were shorter than those in the conventional group[(141.85±18.35)min and(10.18±1.58)d versus(159.46±21.42)min and(12.03±1.82)d,P<0.05].The average intraoperative blood loss in the microscope group was(80.65±7.28)mL,which was less than that(103.52±10.43)mL in the conventional group(P<0.05).The VAS score and SF-36 score at six months postoperatively were better in the microscope group compared to the conventional group[(2.82±0.53)and(79.56±5.68)versus(3.51±0.60)and(72.35±4.77),respectively,P<0.05].Spinal canal area and anteroposterior diameter of the spinal cord between the two groups postoperatively showed statistically significant differences[(138.24±24.32)mm versus(123.62±18.74)mm,(5.42±0.46)mm versus(4.73±0.51)mm,P<0.05].The cervical range of motion at six months postoperatively in the microscope group showed significant difference compared with that in the conventional group[(25.21±3.37)°versus(28.65±3.56)°,P<0.05].The complication rate in the microscope group was lower than that in the conventional group(5.36%versus 18.37%,P<0.05).Japanese orthopaedic association(JOA)and National Death Index(NDI)scores showed statistically significant between-group and time-point difference(P<0.05).Conclusion Microscopic assistance during ACDF for focal OPLL provides a clear field of vision and facilitates effective decompression of the spinal cord by using a drill to remove and thin the ossified focus,thereby improving short-term pain and joint function while reducing the risk of spinal cord injury and other complications.