摘要目的 探讨人工颈椎间盘置换术中切除颈后纵韧带(posterior longitudinal ligament,PLL)的临床疗效及安全性.方法 回顾性分析2006年8月至2009年1月行Bryan人工椎间盘置换31例,男16例,女15例.根据术中颈PLL切除与否,分为颈PLL保留组(14例)和颈PLL切除组(17例).比较两组患者的基本情况、临床效果和影像学结果.结果 两组患者性别分布、年龄、受累节段和随访时间比较,差异均无统计学意义.颈PLL保留组和颈PLL切除组的手术时间分别为(84.3±10.2)min和(90.6±12.5)min,术中出血量分别为(60.4±9.5)ml和(66.2±12.4)ml,两组差异均无统计学意义;所有患者术后均无并发症.两组日本骨科协会(Japanese Orthopaedic Association,JOA)评分改善率及颈痛与上肢痛视觉模拟评分(visual analogue scale,VAS)改善率分别为75.0%±13.0%和86.2%±11.7%;72.7%±18.5%和86.3%±15.8%;72.0%±17.1%和84.0%±13.0%,两组差异均有统计学意义;术后置换节段曲度增加:颈PLL保留组为4.8°±2.7°,颈PLL切除组为3.9°±2.5°,两组比较差异无统计学意义;术后置换节段活动度增加:颈PLL保留组为1.3°±1.0°,颈PLL切除组为1.8°±1.2°,两组比较差异无统计学意义;两组术后脊髓矢状径颈PLL保留组增加(2.2±1.1)mm,颈PLL切除组增加(3.6±0.6)mm,两组比较差异有统计学意义.结论 人工颈椎间盘置换术中切除颈PLL可有效提高患者的临床疗效,颈PLL切除与保留对置换节段曲度及活动度的影响无明显区别.术中切除颈PLL安全可行.

abstractsObjective To investigate the efficacy and safety of the resection of cervical posterior longitudinal ligament (PLL) in Bryan cervical disc arthroplasty. Methods Thirty-one patients underwent Bryan cervical disc implantation only in one level from August 2006 to January 2009 were investigated in this study. Cervical PLL was preserved in 14 patients, but not in other 17 patients. The clinical (JOA score,VAS score for neck and arm pain) and radiographic parameters (the FSU angle, ROM and diameter of the spinal cord) were compared between the two groups. Results No differences were found in terms of age, affected segment, gender, follow-up period, operation time and blood loss between the two groups. Patients underwent removal of cervical PLL were significantly superior to those underwent reservation of cervical PLL in term of clinical outcomes. There were no differences between the two groups with regard to the increase of FSU angle and ROM. However, the diameter of the spinal cord had a significant increase in patients underwent removal of cervical PLL. No severe complication was found in the two groups. Conclusion Removal of the cervical PLL is beneficial for the clinical outcomes and does not have an impact on the angle and ROM of the affected segment. The procedure is safe and feasible.