摘要目的 探讨伴有颈椎后纵韧带骨化的颈椎间盘突出症的临床特点、手术方式及疗效.方法 对2003年6月至2008年6月间伴有后纵韧带骨化的颈椎间盘突出症患者26例进行回顾性分析,男16例,女10例;平均年龄45岁.均在诱因下起病或出现明显加重,病程较短.术前行颈椎X线、CT和MR检查,证实有1-3个节段的颈椎间盘突出,同时伴有多个(≥2个)节段的后纵韧带骨化.术前疼痛视觉模拟评分(visual analogue scale,VAS)4-7分.平均5.3分;日本骨科学会(Japanese Orthopedic Association,JOA)评分5～12分,平均9.3分.13例患者单纯经椎间隙摘除突出的间盘减压;11例接受椎体次全切除减压;2例一期经椎间隙摘除突出的间盘,二期后路椎板切除减压.结果 患者根性疼痛及肢体麻木无力、走路不稳症状明显改善,术后随访12-36个月(平均18个月),术后疼痛VAS评分平均2.5(1～4)分,JOA评分平均14.2(11～16)分,JOA评分改善率平均为63.2%.2例患者出现脑脊液漏,经对症处理后消失,无其他并发症出现.结论 既往无明显临床表现或临床症状较轻微的颈椎后纵韧带骨化患者可因颈椎间盘突出导致临床症状出现或加重.术前明确责任病灶,手术切除突出的椎间盘常可获得良好疗效.

abstractsObjective To discuss the clinical features,surgical method and outcome of cervical discherniation associate with ossification of the posterior longitudinal ligament.Methods Twenty-six patients of cervical disc herniation associated with ossification of the posterior longitudinal ligament from June 2003 to June 2008 were retrospectively analyzed.There were 16 males,10 females,with a mean age of 45 years.One to three levels of cervical disc herniation associated with two or more levels of ossification of the posterior longitudinal ligament were revealed by X-ray film,CT and MRI.The preoperative mean visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) score were 5.3 points (range,4-7 points) and 9.3 points (range,5-12 points) respectively.Thirteen patients were decompressed by only anterior discectomy,11 by corpectomy and 2 by discectomy followed with posterior laminectomy.Results All patients experienced a remarkable recovery from radiculopathy,numbness,weakness and gait disturbance.Follow-up of 18 months(range,12-36 months) showed the mean VAS and JOA score increased to 2.5(1-4) points and 14.2 (11-16)points.The mean improvement rate of JOA was 63.2%.Leakage of cerebrospinal fluid which occurred in 2 cases disappeared afteR proper treatments without other complications.Conclusion The clinical symptoms of ossification of the posterior longitudinal ligament may appear or aggravate because of cervical disc herniation.The outcome is favorable after identifying the primary compressing factor followed by resection of the herniated cervical disc.