游离型颈椎间盘脱出症的手术治疗

目的探讨采用颈前路后纵韧带切除、髓核摘除加融合固定术治疗游离型颈椎间盘脱出症的疗效。方法自2002年3月～2006年6月,采用颈前路经椎体后缘后纵韧带边缘处进入椎管的后纵韧带切除或切开取核加固定融合新方法治疗游离型颈椎间盘脱出症19例。随访6～51个月,对其术后疗效、X线平片及MRI检查进行分析评定。结果根据临床疗效评定标准:优12例,良7例。结论对于游离型颈椎间盘脱出症,应作后纵韧带切除、摘除游离的髓核以提高手术疗效。采用颈前路后纵韧带边缘处进入椎管的后纵韧带切除或切开取核的方法,操作较简单、安全。     

脊髓型颈椎病合并后纵韧带骨化的前路手术治疗

[目的]探讨一期前路手术治疗脊髓型颈椎病合并后纵韧带骨化的临床疗效.[方法]采用颈前路减压治疗脊髓型颈椎病合并后纵韧带骨化患者16例,其中男9例,女7例;年龄48 ～ 72岁,平均58岁.手术采用颈前路椎体次全切除或加椎间隙减压的基础上,切除骨化的后纵韧带,植骨钛网钢板内固定.[结果] 16例随访6～36 (20±15)个月,术前JOA评分为(8.3±3.48)分,术后3个月JOA评分(14.13 ±1.22)分,差异有统计学意义(P＜0.05).[结论]颈前路手术治疗脊髓型颈椎病合并后纵韧带骨化,能够获得彻底的椎管减压和良好的临床效果.     

内窥镜下前路颈椎间盘切除及椎间融合术

目的 观察内窥镜下前路颈椎间盘切除及椎间盘切除及椎间融合术的临床疗效。方法 自2002年10月，对26例患者实施内窥镜下前路颈椎间盘切除及椎间融合术。其中获得3个月以上随访者16例，男12例，女4例；年龄23～65，平均53.2岁。颈椎外伤合并椎间盘突出症3例，脊髓型颈椎病8例，孤立性颈椎后纵韧带骨化2例，神经根型颈椎病3例。单间隙4例，双间隙12例。病变节段：C3.42个，C4.511个，C5.613个，C6.72个。术前ADL评分平均7.2分。于内窥镜下施行手术，彻底减压后植入PEEK椎间融合器。结果 手术时间50～150min，平均120min。术中出血量40～140ml，平均110ml。无一例发生术中并发症，无一例改为开放手术。术后无咽喉部刺激症状，切口内出血1例。16例患者随访3～8个月，平均6.5个月。术后ADL评分平均13.1分，ALD改善率为60.2%。结论 内窥镜下实施前路颈椎间盘切除及椎间融合术具有切口小、组织损伤轻、手术操作安全等优点。适用于C3.4～C5.6区域内的颈椎间盘突出症、脊髓型颈椎病、神经根型颈椎病、位于椎间隙的孤立性后纵韧带骨化症、颈椎外伤导致的单词隙椎间盘损伤合并颈椎不稳者。     

脊髓型颈椎病后纵韧带切除与保留的疗效比较

目的 分析脊髓型颈椎病(cervical spondylotic myelopathy,CSM)前路减压手术中后纵韧带切除与保留的预后及疗效.方法 65例CSM患者行颈前路减压其中后纵韧带切除者31例,未切除者34例.同时行前路钢板内固定.结果 65例患者随访12～56月,平均28.8月.后纵韧带切除组神经功能恢复率76.2%±21.6%,显著高于后纵韧带保留组63.7%+21.3%(P＜0.05).结论 CSM行颈椎间盘摘除髂骨植骨前路钢板内固定,术中同时切除后纵韧带优于保留后纵韧带的临床疗效.     

后纵韧带切除在脊髓型颈椎病前路手术中的应用

目的：探讨脊髓型颈椎病前路手术中行后纵韧带切除的指征。方法和注意事项。方法：回顾性分析了自2001年1月-2002年6月在颈椎前路手术中行后纵韧带切除的38例脊髓型颈椎病患者的临床资料和随访结果。结果：30例获得随访。平均改善率为72.6%，优10例，占33.3%；良12例，占40%；中6例，占20%；差2例，占6.7%，结论：对合并后纵韧带肥厚压迫颈髓或合并颈椎间盘脱出至硬膜外腔的脊髓型颈椎病患者行前路手术中，需切除后纵韧带。彻底减压，疗效满意。     

人工颈椎间盘置换术适应证及疗效探讨

目的 依据影像学评价标准及颈前路手术减压方式的选择探讨颈椎人工椎间盘置换手术的适应证.方法 回顾性分析2008年1月至2009年7月具有完整资料的175例行颈前路手术的颈椎病及颈椎间盘突出症病例,行融合手术145例,人工椎间盘置换术30例.依据术前影像学评价标准对患者进行不同手术:(1)椎间隙减压融合术;(2)游离型椎间盘突出超过相邻椎体后缘高度1/2者,先通过椎间隙摘除游离的间盘组织碎块,再通过椎体次全切除确认是否将游离的间盘组织碎块完全摘除;(3)椎体次全切减压融合术;(4)ProDisc-C人工颈椎间盘置换术.单节段病变的脊髓型颈椎病按融合术及人工椎间盘置换术分组,比较两组日本矫形外科协会(Japanese Orthopaedic Association,JOA)脊髓功能评分,评价两种手术方式疗效;统计并分析术前和术后1、3、6、12个月人工椎间盘置换节段运动范围.结果 单纯椎间盘突出、轻度椎间盘钙化、椎体后缘有较小骨赘形成的颈椎病可以通过椎间隙达到彻底减压行人工椎间盘置换术.椎体后缘有巨大骨赘形成、严重椎间盘钙化、相应椎间隙严重狭窄或融合、后纵韧带骨化、广泛的椎管狭窄需行椎体次全切除才能达到彻底减压.JOA评分平均改善率:融合术者为66.05%,人工椎间盘置换术者为67.13%,差异无统计学意义;人工椎间盘置换节段术后1、3、6、12个月运动范围与术前相比差异无统计学意义.结论 颈椎病及颈椎间盘突出症,只要能通过前路椎间隙达到彻底减压就可行人工椎间盘置换术.单节段脊髓型颈椎病行人工椎间盘置换术和前路植骨融合内固定术近期手术疗效均良好,但人工椎间盘置换术使置换节段的运动范围得到保留.     

前路手术治疗多节段脊髓型颈椎病的分析

目的评价颈前路手术治疗多节段脊髓型颈椎病的术后疗效及并发症。方法33例患者中,14例行多节段椎间盘摘除、植骨前路钢板固定;19例行椎体次全切除长条植骨前路钢板内固定。结果术后平均随访19个月。33例术前JOA评分2~14(8·88±0·64)分,术后最终随访时8~16(14·10±0·39)分,差异有显著性(P<0·01)。优良21例,好转11例,加重1例。术后改善率10%~93%,平均61%。结论对于多节段脊髓型颈椎病不伴有连续性后纵韧带骨化的患者,前路减压植骨融合内固定有显著疗效。     

后路减压ARCH内固定治疗颈椎病合并后纵韧带骨化症的疗效分析

前路颈椎间盘切除作为颈椎病的一种有效治疗手段而得到广泛应用,但对于颈椎病合并颈椎后纵韧带骨化症(OPLL)的患者单纯行颈椎间盘切除往往不能彻底达到对脊髓神经根的减压,术后症状并不缓解,或暂时缓解后又复出现症状,常需再次手术治疗.我院2010 年8月至2011年4月行后路手术治疗OPLL 18例,取得良好手术效果.     

颈椎间盘突出症合并后纵韧带肥厚的手术治疗

目的：探讨颈椎间盘突出症合并后纵韧带肥厚病例的手术治疗问题。方法：回顾分析了经前路手术治疗的颈椎间盘突出症合并后纵韧带肥厚病例８３例,占同期前路手术治疗颈椎间盘突出症病例（３７６例）的２２．０７％。重点介绍了如何选择手术适应症,特别是术中如何判定是否应该切除后纵韧带,手术技巧及注意事项等。结果：全组术后经３～５９个月,平均２０．６个月随访,优良率达９１．５７％。切除之后纵韧带经病理检查证实有增生、肥厚、纤维化等。结论：对典型的颈椎间盘突出症需经前路手术,合并有后纵韧带肥厚者,应在切除突出间盘的同时切除后纵韧带,以使颈髓完全解除束缚,疗效更加趋于完善。     

跳跃性椎体次全切除治疗多节段脊髓型颈椎病及后纵韧带骨化症

 目的 探讨前路跳跃性椎体次全切、分节段减压植骨融合术治疗多节段脊髓型颈椎病及后纵韧带骨化症的疗效。方法 15例多节段(≥3个节段)脊髓型颈椎病或后纵韧带骨化症患者均接受前路跳跃性椎体次全切除减压+自体髂骨或钛网植骨融合+前路钢板固定术。男9例,女6例;年龄51~80岁,平均56岁。术中对C4、C6椎体行次全切,在保留C5椎体基础上切除其后缘增生骨赘、突出的椎间盘和(或)骨化的后纵韧带,在C3~5和C5~7进行结构性植骨,以C5椎体为中间固定椎体行颈前路钢板内固定。术后采用日本骨科协会(Japanese Orthopaedic Association,JOA)评分系统评估神经功能恢复情况;摄X线片和三维CT重建评估融合程度;同时行MR检查,以观察脊髓减压程度和脊髓情况。结果 所有患者均获得9~42个月随访,平均26.7个月。15例患者均达到骨性融合。JOA评分由术前平均(13.44±2.81)分改善至术后(16.16±2.19)分。颈椎序列由术前1.16°±11.74°改善至术后即刻14.36°±7.85°,末次随访时为12.92°±6.17°。术后声嘶2例,吞咽困难1例。结论 前路选择性椎体次全切除结合分节段减压植骨融合术治疗多节段脊髓型颈椎病及后纵韧带骨化症疗效可靠。保留C5椎体提供了额外的把持力、增加了结构的稳定性,避免跨多节段植骨内固定而导致的内固定失败。     

颈椎前路手术中后纵韧带切除的探讨

目的：探讨颈椎前路手术后纵韧带切除的指征、方法和注意事项，方法：对2000年4月－2002年4月后纵韧带切除的50例颈椎前路手术患者的临床资料及手术治疗结果进行回顾性分析。结果：42例获得6个月以上随访，根据JOA评分标准，平均改善率为70．5％，优14例，良16例，中9例，差3例，结论：后纵韧带退变肥厚、后纵韧带骨化或硬膜外型颈椎间盘脱出压迫颈髓时，行颈椎前路手术时应切除后纵韧带，彻底减压。     

硬膜外型颈椎间盘脱出症的诊断和治疗(附97例报告)

目的 :探讨硬膜外型颈椎间盘脱出症的诊断和治疗。方法 :对 1 995年 6月～ 2 0 0 0年 6月经前路手术中证实的 97例硬膜外型颈椎间盘脱出症患者的临床资料及手术治疗结果进行回顾性分析。结果 :84例获得随访 ,优 80例 ,良 2例 ,有效 1例 ,无效 1例 ,无 1例恶化 ,总有效率为 98 8% ,优良率 97 6 %。结论 :硬膜外型颈椎间盘脱出症较多见 ,术中切开后纵韧带 ,摘除髓核 ,可获得满意疗效     

Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament

Multi-level cervical spondylosis and ossification of the posterior longitudinal ligament (OPLL) are well-documented causes of myelopathy. The choice of surgical procedures remain controversial. Between January 1983 and December 1987, we have performed anterior cervical vertebrectomy in 45 patients with cervical myelopathy caused by multi-level spondylosis and OPLL. They consisted of 19 patients with cervical spondylosis, 12 with OPLL, and 14 with combined lesions of both cervical spondylosis and OPLL. There were 32 men and 13 women. The mean age was 55 years, ranging from 35 to 70 years. In all of our 45 patients, anterior vertebrectomy, discectomy, removal of posterior osteophytes and OPLL, and interbody fusion were done for progressive myelopathy refractory to conservative treatment. In 2 of 45 patients, 5 vertebral bodies were resected; in 3 patients, 4 vertebral bodies were resected; in 12 patients, 3 vertebral bodies were resected, in 19 patients, 2 vertebral bodies were resected; and in 9 patients, 1 vertebral body was resected. Thirty-nine of 45 patients (87%) had good results. Neurological signs did not improve in 5 patients (11%). One patient died because of agranulocytosis secondary to treatment with antibiotics. In conclusion, cervical cord compression caused by lesions located principally in the anterior aspect of the spinal canal may be completely relieved via anterior vertebrectomy, discectomy, removal of the calcified ligament, and fusion.     

Laminectomy with posterior wiring and fusion for cervical ossification of the posterior longitudinal ligament, spondylosis, ossification of the yellow ligament, stenosis, and instability: a study of 5 patients

Cervical laminectomy with posterior wiring and fusion is valuable for the management of cervical ossification of the posterior longitudinal ligament (OPLL), spondylosis, ossification of the yellow ligament (OYL), stenosis, and instability. Within 1.5 years, five patients averaging 73 years of age developed severe myelopathy. Dynamic radiographs confirmed an intact cervical lordosis with active subluxation and instability at one or two levels, whereas magnetic resonance and computed tomography scans showed OPLL, spondylosis, OYL, and stenosis. After multilevel laminectomy with posterior wiring and fusion and immobilization in cervicothoracic orthoses, patients fused in an average of 3.6 months. All patients improved, showing mild to moderate residual postoperative myelopathy an average of 13 months later (range, 6-19 months). With an intact cervical lordosis, laminectomy with posterior wiring and fusion was used successfully to manage five patients with OPLL, spondylosis, OYL, stenosis, and instability.     

颈椎病患者突出椎间盘的MRI测量及临床意义

目的:探讨颈椎病患者突出椎间盘MRI测量的临床意义。方法:回顾分析99例接受颈椎前路间盘摘除植骨融合手术的颈椎病患者的临床资料,其中硬膜外型椎间盘突出18例,非硬膜外型椎间盘突出81例。测量MRI横断面椎间盘突出层面的椎间盘前后径、椎体前后径、椎管前后径、椎管最小径,算出椎管侵占率和椎管矢状径比减小值,对硬膜外型椎间盘突出和非硬膜外型椎间盘突出的两组病例行统计学分析。结果:两组数值间有统计学差异,硬膜外型椎间盘突出椎管侵占率﹥0.45,椎管矢状径比减小值﹥0.23,非硬膜外型椎间盘突出椎管侵占率﹤0.58,椎管矢状径比减小值﹤0.39。结论:颈椎病患者突出椎间盘的MRI测量有助于术前评估是否为硬膜外型椎间盘突出,当椎管侵占率>0.45,椎管矢状径比减小值>0.23,可疑是硬膜外型椎间盘突出,要求仔细检查后纵韧带是否破损;当椎管侵占率>0.58,椎管矢状径比减小值>0.39,可诊断为硬膜外型椎间盘突出,要求切除后纵韧带,取出椎管内的椎间盘。     

Histopathological studies of the osteophytes and ossification of the posterior longitudinal ligament (OPLL) in the cervical spine

To obtain information on ossification around the vertebral body of the cervical spine, we carried out histopathological investigation on 30 autopsy cases. The results were as follows; Intervertebral discs were untouched, anterior osteophytes developed along the anterior longitudinal ligament and they corresponded to anterior spur in spondylosis deformans. Posterior osteophytes around the posterior edges of vertebral body resulted in intervertebral insufficiency, and corresponded to hypertrophic spur in osteochondrosis. Histopathological findings of hyperostotic anterior osteophytes were similar to anterior osteophytes, but in the former there were advanced osteophyte formations. In OPLL of the segmental type, intervertebral discs were degenerated, and ossified mass did not involve the posterior longitudinal ligament of the parts of discs. With regard to morphological appearance and the tendency of increasing ossification, OPLL of the continuous type was similar to hyperostotic anterior osteophytes, without involvement of intervertebral disc. OPLL of the distinctly continuous type was differentiated from that of the segmental type.     

非创伤性硬膜外游离型颈椎间盘突出症的诊断和治疗

目的:探讨非创伤硬膜外游离型颈椎间盘突出症的临床特点和治疗方法。方法:自2002年1月至2011年7月采用颈前路椎体次全切除并后纵韧带切除髓核摘除减压内固定术治疗非创伤硬膜外游离型颈椎间盘突出症患者10例,其中男6例,女4例;年龄42～65岁,平均48.2岁;病程1个月～4年,平均15个月。所有患者术前有不同程度的四肢麻木、无力、行走不稳及括约肌功能障碍。术前颈椎MRI均提示有节段性颈脊髓受压。术前及术后随访时按JOA评分标准进行神经功能评分。结果:10例患者经术后15～32个月随访(平均21个月),无手术相关并发症发生。10例患者术前颈椎MRI显示,穿破后纵韧带游离于椎体后方的髓核在T1相上和相应病变椎间隙等信号,而在T2相上为等或高信号。患者术后JOA评分由术前的7.20±1.55提高到13.60±1.90(t=-11.8,P<0.001),其改善率为66.7﹪,优3例,良6例,可1例。结论:明确诊断后早期行前路椎体次全切除并后纵韧带切除髓核摘除减压内固定术是治疗非创伤硬膜外游离型颈椎间盘突出症成功的关键。     

伴上肢局部水肿的颈椎病与颈椎减压术的关系

[目的]探讨伴有上肢局部水肿的颈椎病患者的发病机理和与手术颈椎减压的关系。[方法]总结分析4a来收治的10例伴有上肢局部水肿的颈椎病人，其中脊髓型颈椎病7例，神经根型颈椎病2例，后纵韧带骨化型1例，7例行前路椎体次全切减压植骨内固定，1例行前路椎体次全切＋单间隙间盘摘除植骨内固定，2例行后路减压植骨内固定，术后观察患者水肿消退情况。[结果]10例病人上肢局部水肿不同程度消退，前路手术者较后路手术者消退快。[结论]颈椎病患者上肢水肿的发生与颈交感神经受激惹有关，通过前路或后路颈椎管减压，去除颈椎不稳、椎间盘突出、骨赘等交感神经受激惹因素，水肿可逐步消退。     

Diagnosis and surgical management of cervical ossification of the posterior longitudinal ligament.

BACKGROUND CONTEXT: The diagnosis and treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL) is continuing to evolve as its effects become more readily recognized and surgical alternatives expand. PURPOSE: To review the clinical, neurodiagnostic and surgical management of OPLL. STUDY DESIGN/SETTING: Patients with early OPLL, often in their mid-forties, present with radiculopathy or mild/moderate myelopathy. Radiographically, hypertrophy of the posterior longitudinal ligament with punctate ossification appears opposite multiple disc spaces. Patients with classic OPLL frequently become symptomatic in their mid-fifties with radiographic characteristics showing ossification of the ligament behind the vertebrae alone (segmental), behind the vertebrae including the intervertebral disc spaces (continuous), and combinations of the segmental and continuous variants and OPLL opposite disc spaces alone. Both magnetic resonance imaging (MRI) and computed tomography (CT) examinations are critical. MRI better delineates the extent of soft tissue abnormalities in three dimensions, including the cervicothoracic junction, whereas CT more readily identifies the foci of frank ossification. Surgical alternatives include anterior, posterior or combined approaches. Anterior surgical options include plated multilevel anterior discectomy and fusion, anterior cervical corpectomy with fusion (ACF), or plated multilevel ACF with differing posterior fusion techniques. Posterior surgical options vary from laminectomy with or without simultaneous fusion and laminoplasty. Although outcomes with different approaches vary, many direct anterior resection techniques achieve more favorable results because of appropriate and adequate resection of the ligament. CONCLUSIONS: The clinical and neuroradiographic documentation of OPLL and its appropriate surgical management anteriorly, posteriorly or circumferentially remain a therapeutic challenge.