后路椎板切除联合钉棒系统固定治疗颈椎后纵韧带骨化症的疗效分析

目的探讨后路椎板切除联合钉棒系统固定治疗颈椎后纵韧带骨化症的疗效、并发症及其影像因素。方法2002年1月-2006年12月，采用后路椎板切除联合钉棒系统固定治疗颈椎后纵韧带骨化症患者54例，采用JOA评分评价患者神经功能恢复，将患者分为疗效良好、疗效不佳2组。分析患者年龄、性别、症状持续时间、神经功能、合并糖尿病、椎管矢状径、颈椎曲度、椎管狭窄率、骨化物分型、脊髓压迫率、脊髓高信号等相关因素对患者手术疗效的影响。结果随访1-4年，平均2，3年。术后患者脊髓前后径及神经功能JOA评分明显提高，但颈椎曲度改善不明显。其中35例患者手术疗效良好，19例患者疗效不佳，多因素分析示患者术前颈椎曲度及骨化物横断面分型可影响患者手术疗效。本组并发症包括7例C5神经根麻痹，5例颈肩部的轴性痛和2例血肿压迫。结论后路椎板切除联合钉棒系统固定是一种适合于治疗多节段颈椎后纵韧带骨化症的手术方式，患者术前颈椎曲度及横断面骨化分型对患者手术疗效具有重要意义。

Posterior laminectomy and screw-rod system fixation in the treatment of cervical ossification of posterior longitudinal ligament

Objective To discuss the outcome, complications and related factors of posterior laminectomy and screw-rod system fixation in the treatment of cervical ossification of posterior longitudinal ligament (OPLL). Methods Between January 2002 and December 2006, a total of 54 patients with cervical OPLL underwent posterior laminectomy and screw-rod system fixation. The patients were classified into a good-prognosis group and a poor-prognosis group according to the JOA neruologic scoring system. Age, sex, duration of symptoms, JOA score, diabetes mellitus, diameter of the canal, cervical lordosis, occupying rate, type of ossification, cord flattening rate, and hyperintense areas were testified using multifactorial analysis.Results After a followed up of 1-4 years with an average of 2.3 years, the cord diameter and neurological JOA score increased significantly after operation, but the cervical lordosis didn't. Among the patients, 35 had excellent or good results, and 19 had fair or poor results. Preoperative ervical lordosis and type of ossification in the axial images were the statistically significant factor predicting clinical results in this study. The compicaltions included C₅ palsy in 7 cases, axial pain in 5 cases and hematoma in 2 cases. Conclusion Posterior laminectomy and screw-rod system fixation is a useful surgical option for multilevel OPLL. Preoperative ervical lordosis and axial type of ossification are important to surgical results.