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颈椎后纵韧带骨化症再手术原因分析

Reoperation to the ossification of the posterior longitudinal ligament

摘要:

目的 通过分析颈椎后纵韧带骨化症再手术的原因,探讨确定手术方式的影响因素.方法 对2005年6月至2010年7月收治的36例颈椎后纵韧带骨化症再手术患者资料进行回顾性分析,男性23例,女性13例;年龄39~72岁,平均57岁.患者首次手术距再手术时间4个月至24年,平均3.9年.比较术前术后的X线片、CT和MRI.首次手术为颈前路椎体次全切除的20例患者中,14例合并颈椎管狭窄,10例后纵韧带骨化(OPLL)切除不彻底,5例术中颈脊髓损伤,1例相邻节段椎间盘突出;首次手术为颈后路椎管扩大椎板成形术的14例患者中,6例前方OPLL仍有压迫,4例后方减压节段不足,2例局部后凸,2例OPLL进展合并椎间盘突出;第3次手术的患者2例,1例前后路两次手术后前方OPLL仍有压迫,1例是前后路手术后前方融合的相邻节段椎间盘突出.通过日本骨科学会(JOA)评分判断再手术疗效,并统计再手术并发症.结果 30例患者获得随访,随访时间1.5 ~4.0年,平均1.8年.36例再手术的患者中无术后神经症状加重病例,2例无效.34例有效的患者的JOA改善率为31.2%.22例再手术为颈后路椎管扩大椎板成形术的患者中3例出现术后C5神经根麻痹,14例再手术为颈前路椎体次全切除术的患者中3例出现脑脊液漏.结论 颈椎后纵韧带骨化症的手术治疗方式应根据OPLL分型、是否合并颈椎管狭窄来确定.

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abstracts:

Objective To discuss surgical approaches of ossification of the posterior longitudinal ligament(OPLL) of cervical spine.Methods Between June 2005 to July 2010,36 patients with OPLL of cervical spine were reoperated.There were 23 male,13 female,age from 39 to 72 years( mean 57 years).The time of the first operation to the reoperation were 4 months to 24 years,an average of 3.9 years.Among 20 patients underwent anterior corpectomy and fusion(ACD) at first operation,14 cases combined stenosis of cervical spinal canel,10 cases were insufficient decompression of OPLL,5 cases injuried of cervical spinal cord during the first operation,1 case was adjacent disc herniation.Among 14 cases underwent expensive open-door laminoplasty (ELAP)at first operation,6 cases were insufficient decompression of OPLL,4 cases were inadequate decompressed segment,2 cases were cervical segmental kyphosis,2 cases were progression of OPLL combined with disc herniation.Among 2 cases underwent combined approach at first operation,I case was insufficient decompression of OPLL,the other was adjacent disc herniation.Their pre- and post-operative X-ray,CT and MRI were analyzed.The complications of reoperation were recorded.Result There were 30 patients followed-up,with a period of 1.5-4.0 years,average 1.8 years.With 36 patients,none had deterioration,2 patients had no recovery post-reoperation,34 patients had 31.2% Japanese Orthopedic Association score improve rate.Among 22 cases underwent ELAP at second operation,3 cases had postoperative segmental palsy.Among 14 cases underwent ACD at second operation,3 cases had intraoperative dural defects.Conclusion Surgical strategy for OPLL of cervical spine should consider the type of OPLL and stenosis of cervical spinal canel.

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作者: 潘胜发 [1] 刘忠军 [1] 孙宇 [1] 张凤山 [1] 王少波 [1] 李迈 [1] 张立 [1]
第一作者: 潘胜发
期刊: 《中华外科杂志》2012年50卷7期 607-610页 MEDLINEISTICPKUCSCD
分类号: R686.5
栏目名称: 颈椎后纵韧带骨化
DOI: 10.3760/cma.j.issn.0529-5815.2012.07.009
发布时间: 2012-10-29
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