颈椎后纵韧带骨化症的手术疗效分析

目的探讨不同术式治疗颈椎后纵韧带骨化症（ossification of posterior longitudinal ligament，OPLL）的疗效和MRIT2脊髓高信号（increased signal intensity．ISI）对预后的影响。方法分析132例因OPLL行手术治疗的病例．其中前路手术46例．后路手术59例，前后路联合手术27例。统计手术前后JOA评分及术后改善率，分析不同术式的疗效及MRIT2脊髓高信号对预后的影响。结果三组病例JOA评分均较术前明显提高，差异有统计学意义；前路组改善率为（74．95±9．83）％，后路组改善率为（69．90±9．56）％，前后路联合组改善率为（76．61±10．19）％，前路组和前后路联合组的改善率均优于后路组．差异有统计学意义；术前有ISI组改善率为（67．04±7．91）％，无ISI组改善率为（77．88±9．11）％，差异有统计学意义。结论a）三种术式均可获得较好的疗效，但前路手术和前后路联合手术的改善率优于后路手术；b）术前无MRIT2脊髓高信号者的预后相对较好。

The Analysis of Cervical Ossification of Posterior Longitudinal Ligament Surgery

Objective To discuss the results of ossification of posterior longitudinal ligament（OPLL） of cervical spine with different surgical approaches and the influence of increased signal intensity of the spinal cord on T2-weighted MRI to the prognosis. Methods Retrospectively analyze 132 patients with OPLL of cervical spine by surgical treatments. Forty-six of them were decompressed from an anterior approach, 59 from a posterior approach and 27 from a posterior-anterior approach. Record the JOA scores of preoperative and postoperative. Calculate the improvement rate after operation. Analyze the outcomes of the three different operations and the influence of increased signal intensity of the spinal cord on T2 weighted MRI to the prognosis. Results Three groups postoperative JOA score im proved significantly and the differences were significant. The postoperative improvement rate was （74.95 ± 9.83）%in patients treated by anterior decompression, （69.90± 9.56）% in those treated by posterior decompression and （76.61 ± 10. 19） % in those by posterior-anterior approach surgical treatment. The postoperative improvement rate of anterior surgery and posterior-anterior surgery were superior to posterior surgery and the differences were statistically significant. The postoperative improvement rate was（67.04±7.91）% in ISI group and（77.88±9.11）% in no ISI group and the difference was statistically significant, Conelusion a）All of the three surgical proceduredures cnn gel good effect, but the postoperative improvement rate of anterior surgery and posterior-anterior combined surgery are superior to posterior surgery;b）The patients who have no increased signal intensity of the spinal cord on T2-weighted MR1 have better prognosis.