颈椎侧块钢板在颈椎后纵韧带骨化症后路减压中应用的探讨

Cervical Ossification of the Posterior Longitudinal Ligament Treated by Total Laminectomy and Internal Fixation of Cervical Lateral Mass Plate

目的 :探讨在颈椎后纵韧带骨化症患者实施后路全椎板切除减压后 ,应用颈椎侧块钢板内固定的方式、疗效。方法 :1999年 6月～ 2 0 0 2年 3月 ,在颈后路减压中采用颈椎侧块钢板内固定加植骨术治疗颈椎后纵韧带骨化症 (OPLL) 13例。后正中切口 ,显露至两侧关节突外缘 ,根据脊髓受压节段行全椎板切除后 ,采用Magerl方法 (即螺钉的进入点位于侧块中心内上侧 2mm ,钉的走行方向约向外侧倾斜 2 0～ 2 5° ,向头侧倾斜 3 0～ 40°) ,行颈椎侧块钢板内固定加植骨术。结果 :随访 8个月～ 2年 6个月 ,平均 19个月。根据JOA评分标准 ,平均改善率为 64 .5 % ,优 6例 ,良 4例 ,中 2例 ,差 1例。未发生椎动脉或神经根损伤、脊髓损伤等严重并发症。结论 :OPLL行后路全椎板切除减压 ,能有效改善颈椎管狭窄 ,同时予以颈椎侧块钢板内固定 ,能避免全椎板切除对颈椎稳定性的影响 ,有效地保护颈椎的稳定性 ,从而取得满意疗效。

Objective: To discuss the application of total laminectomy and cervical lateral mass plate for the treatment of ossification of the posterior longitudinal ligament(OPLL).Methods:From Jun.1999 to Mar.2002,internal fixation with cervical lateral mass plate and bony fusion were performed in 13 patients during posterior decompression for the treatment of OPLL.A posterior median approach was used to expose the lateral edge of the articular process.All patients received total laminectomy according to the compression segment of spinal cord.A cervical lateral mass plate was applied in each lateral mass,a suitable biocortical screw was inserted using Magerl technique(the inserting point of the screw was 2mm medial and superior to the center of lateral mass,the direction was 20～25° laterally and 30～40° cranially).Results: The follow up of all 13 cases ranged from 8 months to 2 years and 6 months(with the mean of 19 months).The mean recovery rate based on the scoring system of the Japanese Orthopaedic Association(JOA) was 64.5%,6 cases were excellent,4 cases were good,2 cases were fine,1 case was bad.No severe complications such as injuries of vertebral artery,nerve root and spinal cord or aggravation of spinal cord injury occurred.Conclusions:The satisfactory decompression of spinal cord can be obtained by total laminectomy for OPLL and the complication of cervical unstability can be diminished by cervical lateral mass plate fixation.Clinical result is satisfactory following the above mentioned procedure.