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颈椎后纵韧带骨化症间接减压术后轴性症状分析

Analysis of axial symptoms after indirect decompression for ossification of the posterior longitudinal ligament of the cervical spine

摘要:

目的 探讨间接减压治疗颈椎后纵韧带骨化症术后轴性症状产生的原因及临床意义.方法 回顾性分析2005年2月至2010年2月接受手术治疗的颈椎后纵韧带骨化症76例患者资料,其中男性34例,女性42例;年龄37~74岁,平均52.1岁.病程11~56个月,平均32.1个月.患者分别行全椎板切除减压术(椎板切除组,19例)、单开门椎管扩大椎板成形术(扩大成形组,33例)、全椎板减压侧块螺钉内固定术(内固定组,24例).所有患者术前及术后均行颈椎X线片检查,术后对3组患者颈椎曲度指数(CCI)的丢失程度、日本骨科学会(JOA)评分的改善率、轴性症状的发生及严重程度进行评估.采用x2检验、SNK检验进行统计分析.结果 患者均获得随访,随访时间14~35个月,平均(21±5)个月,椎板切除组、扩大成形组及内固定组的CCI的丢失程度分别为4.2%±1.7%、2.9%±2.2%及2.3%±1.9%,差异有统计学意义(F=117.5,P<0.01);椎板切除组与扩大成形组、内固定组比较,差异均有统计学意义(q =2.94和4.23,P<0.01).JOA评分改善率椎板切除组为58.3%、扩大成形组为64.3%、内固定组为66.7%,差异无统计学意义(P>0.05).椎板切除组、扩大成形组及内固定组早期(术后3个月)轴性症状的发生率分别为7/19、30.3%及33.3%,差异无统计学意义(P>0.05);晚期轴性症状的发生率分别为5/19、12.1%及8.3%,3组比较差异有统计学意义(x2=13.762,P<0.01);椎板切除组与扩大成形组、内固定组比较,差异均有统计学意义(x2=6.368和11.481,P<0.01).末次随访时椎板切除组患者未发生明显后凸畸形,扩大成形组患者无“关门”现象出现,内固定组患者无内固定物松动、断裂、脱出及相关神经血管并发症发生.结论使用颈椎间接减压3种术式治疗颈椎后纵韧带骨化症术后早期轴性症状的发生率无差别,全椎板切除减压术后晚期轴性症状的发生率高于其他2种术式,可能与颈椎曲度的丢失有关.

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abstracts:

Objective To study the etiology and clinical significance of axial symptoms after posterior operative procedures for ossification of the posterior longitudinal ligament (OPLL).Methods From February 2005 to February 2010,76 patients with OPLL treated were retrospectively experienced.There were 34 male and 42 female with average of 52.1 years ( range from 37 to 74 years),the average duration of the disease was 32.1 months ( range from 11 to 56 months ).Nineteen patients underwent traditional laminectomy in group A,33 patients received open-door laminoplasty in group B and 24 patients underwent lateral mass screw fixation in group C.All patients underwent X-ray examination pre- and post operative,computed tomography were used for diagnosis of OPLL,the recovery rate was calculated using pre- and postoperative Japanese Orthopedic Association (JOA) scores for each patient.Pre- and postoperative cervical curvature index and axial symptoms were measured and compared.x2 test and SNK test were used as statistical methods.Results All patients were followed up for 14-35 months,average ( 21 ± 5 )months.Loss of cervical curvature index was 4.2% ± 1.7% in group A,2.9% ±2.2% in group B and 2.3% ± 1.9% in group C.The difference was significant in loss of cervical curvature indice between group A and B ( q =2.94,P < 0.01 ),group A and C ( q =4.23,P < 0.01 ).The average JOA recovery rate was 58.3% for group A,64.3% for group B and 66.7% for group C.There was no significant difference in JOA recovery rate among the three groups( P >0.05 ).The rate of early evident axial symptoms was 7/19 in group A,30.3% in group B and 33.3% in group C and the difference was not statistically significant ( P >0.05).The incidence of late evident axial symptoms was 5/19 in group A,12.1% in group B and 8.3% in group C,the difference was not significant between group B and C (x2 =13.762,P < 0.01 ),but of statistical difference between group A and B ( x2 =6.368,P < 0.01 ),group A and C ( x2 =11.481,P <0.01 ).No kyphotic deformity in the group A,no "Close Door" phenomenon in group B and no internal failure in group C.Conclusion The incidence of early axial symptoms are of no significant difference among the three groups,but late axial symptoms are higher in the laminectomy than other groups,which may be associated with loss of cervical lordosis.

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