摘要目的 探讨术前颈椎不稳和术中不同内固定对多节段颈椎后纵韧带骨化症(OPLL)患者行颈椎管后路单开门扩大成形减压术后并发轴性痛(PAP)特征和门轴侧骨槽融合率影响.方法回顾性分析2010年1月—2014年4月武警部队后勤学院附属医院和天津医院脊柱外科106例OPLL患者的临床资料.其中男82例,女24例;年龄51~68岁,平均58.7岁;均行颈椎管后路单开门扩大成形减压术.按照患者术前合并颈椎不稳与否,分为颈椎不稳组(36例)和颈椎稳定组(70例);再按照辅助内固定装置类型,将颈椎不稳组36例分为连续节段Centerpiece微型钛板固定组(14例)和椎弓根钉棒固定组(22例),颈椎稳定组70例分为椎弓根钉棒固定组(17例)和微型钛板固定(53例).所有患者术后均随访3年以上,比较两组患者PAP发生率,以及组内实施不同内固定术式的两亚组间术后3个月门轴侧骨槽融合率、PAP发生率、首发时间、严重程度和持续时间.结果术后颈椎不稳组PAP发生率高于颈椎稳定组,两组分别为27.78%(10/36)和11.43%(8/70),差异有统计学意义(χ2=4.516,P<0.05).颈椎稳定组患者,椎弓根钉棒固定术后3个月门轴侧骨槽融合率高于Centerpiece微型钛板,差异有统计学意义(t=2.995,P<0.05);椎弓根置钉术后PAP持续时间短于Centerpiece微型钛板固定,差异有统计学意义(t=11.450,P<0.05);两亚组PAP发生率、首发时间和严重程度间比较,差异均无统计学意义(P值均>0.05).术前颈椎不稳组患者,椎弓根固定组术后PAP发生率低于微型钛板固定组,差异有统计学意义(χ2=9.841,P<0.05);两亚组PAP首发时间、严重程度、持续时间和术后3个月门轴侧骨槽融合率间比较,差异均无统计学意义(P值均>0.05).结论术前颈椎不稳患者更易继发PAP,其辅助椎弓根较微型钛板固定者可在一定程度减少PAP发生率.术前颈椎稳定患者行颈椎管后路单开门扩大成形减压术治疗时,联合应用椎弓根钉棒较Centrepiece微型钛板固定,更有利于提高早期门轴侧骨槽融合率和缩短PAP持续时间.

abstractsObjective To analyze the influence from preoperative instability and intraoperative different internal appliances on union rate of hinge trough and characteristics of postoperative axial pain ( PAP) after decompression of unilateral expansive laminoplasty for patients with multilevel ossification of cervical posterior longitudinal ligament(OPLL). Methods From January 2010 to April 2014, the study retrospectively reviewed 106 OPLL patients who underwent unilateral laminoplasty supplemented by continuous mini-plates or pedicular screws fixation with a minimum of 36 months of follow-up. According to complicated with preoperatively cervical instability or not, the sufferers were divided into cervical steadiness group and unsteadiness group. Subsequently, every group was divided into fixation of mini-plate and transpedicular screw subgroups in terms of instrumentation types. Thirty-six cases of preoperative instability comprised of 22 cases of pedicle fixation and 14 cases of mini-plates. Seventy cases of preoperative stability included 17 cases of pedicle fixation and 53 cases of mini-plate. The prevalence, initial onset, severity, duration of PAP and union rate of hinge groove at postoperative 3 months were compared to analyze the influence of two internal methods and preoperative unsteadiness on features of PAP. Results Significantly statistic difference in incidence of PAP between preoperative unsteadiness group ( 27. 78%, 10/36 ) and steadiness group(11. 43%, 8/70) existed(χ2 =4. 516, P<0. 05). Without the condition of preoperatively cervical instability, fusion rate of hinge groove in pedicle group was higher than that in mini-plate group, the P value reached significantly statistic difference(t=2. 995, P<0. 05). Duration of PAP in pedicle group appeared to be shorter than that in mini-plate group, the difference reached statistic significance ( t =11.450, P < 0. 05). There were no significantly statistic differences in other parameters between two subgroups respectively(P>0. 05). With the state of preoperative instability, incidence of PAP in pedicle group was lower in comparison of that in mini-plate group, the difference achieved statistic significance(χ2 =9. 841, P=0. 042). There were no significantly statistic differences in other index between two subgroups respectively(all P values>0. 05). Conclusions Pedicle fixation is prone to reducing incidence of PAP in contrast to mini-plate fixation to some extent under the condition of preoperative instability which tends to induce occurrence of PAP. The study suggests that pedicular fixation will be beneficial to improving and promoting fusion ratio of hinge groove and shortening duration period of PAP under the condition of cervical stability.