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颈椎后纵韧带骨化症的手术方式选择及疗效

Surgical options and clinical outcomes of cervical ossification of the posterior longitudinal ligament

摘要:

目的 探讨颈椎后纵韧带骨化症手术方式选择及临床疗效.方法 回顾性分析2006年1月至2010年12月经同一治疗组手术治疗的颈椎后纵韧带骨化症63例患者资料,其中男性49例,女性14例;年龄38 ~ 76岁,平均56.2岁.病程2个月至20年,平均3.2年.按照骨化物矢状面及横断面分型、骨化物范围及颈椎生理曲度选择不同手术方式.记录并发症,采用日本骨科协会(JOA)评分来评价神经功能,以视觉模拟量表(VAS)评价颈痛情况.术前、术后及末次随访结果比较并采用t检验进行统计学分析.结果 本组患者行前路手术35例,术前JOA评分(9.8±2.3)分,末次随访时为(11.7±2.1)分(t=3.28,P<0.05);术前VAS评分与末次随访时比较,差异有统计学意义(t=3.15,P<0.05).患者行后路椎板切除术12例,术前JOA评分为(10.4±2.7)分,末次随访时为(12.5±2.3)分(t=3.81,P<0.05);行单开门椎管扩大术14例,术前JOA评分为(9.7±2.5)分,末次随访时为(11.6±2.6)分(t=3.56,P<0.05).行后路手术的患者术前VAS评分与术后3个月及末次随访比较,差异均无统计学意义(P>0.05).行前后路联合手术2例.本组行前路手术患者术后出现神经功能恶化1例,脑脊液漏2例;椎板切除内固定术后C5神经根麻痹2例.结论 颈椎后纵韧带骨化症手术方式的选择应依据骨化物类型、范围及患者生理曲度等情况综合考虑;只要手术方式选择得当,均能达到改善神经功能的效果.

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abstracts:

Objective To discuss the options and clinical outcomes of surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL).Methods From January 2006 to December 2010,63 patients of cervical OPLL treated surgically by same team were retrospectively analyzed.There were 49 males,14 females,with a mean age of 56.2 years (from 38 to 76 years).The duration of symptoms ranged from 2 months to 20 years (mean 3.2 years).The ossified ligament was classified via sagittal and coronal images on CT scan.The cervical curvature was measured.Choice of surgical methods was determined according to the type of ossified ligament and cervical curvature.All complications occurred was recorded.The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the neurological status.The severity of cervical pain was assessed with visual analogue scale (VAS) method.The results of preoperative,postoperative and follow-up were statistically compared with student t test.Results The JOA scores of 35 patients performed with anterior approach improved from 9.8 ± 2.3 preoperatively to 11.7 ±2.1 at final follow-up( t =3.28,P < 0.05 ).The VAS sore was significantly decreased at final follow-up compared with preoperative (t =3.15,P < 0.05).While the JOA scores improved from 10.4 ± 2.7preoperatively to 12.5 ± 2.3 at final follow-up ( t =3.81,P < 0.05 ) in 12 patients with laminectomy and from 9.7 ± 2.5 to 11.6 ± 2.6 in 14 patients with laminoplasty( t =3.56,P < 0.05 ),The VAS score either in laminectomy or in laminoplasty has not significantly difference between preoperative,3 month postoperative and final follow-up ( P >0.05).Two patients underwent a combined anterior-posterior approach procedure.Complications in patients included 1 patient of postoperative neurologic deteriation and 2 cases of cerebrospinal fluid leakage in patients with anterior approach,and 2 cases of C5 nerve palsy in patients with laminectomy.Conclusions Surgical options of cervical OPLL should be determined by detailed study of type and range of ossified ligament,as well as the cervical curvature of patients.Good neurological function can be expected in case of appropriate choosing the method for treating the cervical OPLL.

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