颈前路减压植骨术治疗后纵韧带骨化症

目的：分析颈椎后纵韧带骨化症的前路减压融合手术效果。方法：对４３例短节段后纵韧带骨化症进行颈椎前路减压植骨手术,男３１例,女１２例,其中切除１个椎节１０例（Ｉ组）,２个椎节１４例（Ⅱ组）,３个椎节１９例（Ⅲ组）,采用ＪＯＡ评定标准及颈椎Ｘ线拍片进行评判。     

后纵韧带骨化症的手术治疗之二：前路减压融合术

前述研究发现占位率〉60％的后纵韧带骨化症后路椎管成形术疗效较差。后续的研究分析了1996年后作者行前路减压融合术治疗的后纵韧带骨化病例。27例患者于1996年～2003年间接受前路手术治疗。平均随访6年（2～10年）。神经功能采用JOA评分评价。手术效果与前述研究中66例患者的资料进行了统计对比。结果显示，在占位率〉60％的后纵韧带骨化病例中，     

混合型颈椎后纵韧带骨化症的前路手术治疗

[目的]探讨混合型颈椎后纵韧带骨化症前路椎体次全切除减压的方法及其临床效果。[方法]对37例混合型颈椎后纵韧带骨化症的患者采用一期前路手术治疗,手术依据钙化的后纵韧带和硬脊膜粘连的情况采用彻底切除钙化后纵韧带或使之"漂浮"的方法。其中男24例,女13例;平均54.3岁。患者椎管狭窄率在32%~85%,平均51.4%。神经功能JOA(Japanese orthopaedic association)评分术前4~14分,平均7.9分。[结果]所有患者随访6个月~3年,平均16个月。术后3个月评分10.3分,术后12个月评分11.1分。优良率分别为72.7%和78.8%。[结论]一期行前路椎体次全切术治疗混合型颈椎后纵韧带骨化症,能够获得彻底的椎管减压和良好的临床效果。     

前路开槽减压及Orion钢板固定治疗颈椎后纵韧带骨化症

随着影像技术的发展,诊断水平不断提高,颈椎后纵韧带骨化症（ＯＰＬＬ）呈上升趋势。治疗方面,被许多学者所推崇的后路间接减压,发展至前路直接减压＋植骨融合术。前者较为安全简单,并为广泛采用,但后者能直接有效地减压,更是一种理想的治疗方法。植骨节段的稳定性一直未得到很好解决,影响了颈前路手术疗效。目前ＡＯ、Ｏｒｉｏｎ等颈前路钢板等在全国逐渐广泛开展,初步报道疗效确切。解决了植骨融合及节段稳定的问题。我院骨科自１９９８年６月～２０００年１月,采用颈前路开槽减压植骨Ｏｒｉｏｎ钢板内固定治疗颈椎后纵韧带骨化…     

前路开槽减压及ORION钢板固定治疗颈椎后纵韧带骨化症

<正> 随着影像技术的发展,诊断水平的不断提高,颈椎后纵带骨华症呈上升趋势。治疗方面,被许多学者所推崇后后路间接减压,发展至前路直接减压+植骨融合术。前者较为安全简单,并为广泛采用,但后者能直接有效地减压,更是一种理想的治疗方法。植骨节段的稳定性一直未得到很好解决,影响了颈前路手术疗效。目前AO、ORION等颈前路钢板等在全国逐渐广泛开展,初步报到疗效确切。解决了植骨融合及节段稳定的问题。我院骨科自1998年6月～2001年1月,采用颈前路开     

颈椎后纵韧带骨化症的前路骨化灶悬切减压治疗

目的 探讨颈椎后纵韧带骨化症采取颈前路骨化灶悬切减压治疗效果.方法 颈椎后纵韧带骨化症42例136个骨化节段.颈前路椎体开槽,深至椎体后缘,与硬膜严重粘连不宜切除的骨化灶可用丝线缝穿骨化灶一侧残余的后纵韧带或骨化灶周围的纤维组织,轻轻提起系在植骨块或颈长肌上,使骨化灶完全缩入骨槽内;对体积较小、与硬膜粘连轻的骨化灶予以...     

胸椎后纵韧带骨化症13例分析

目的：进一步认识胸椎后纵韧带骨化（ＴＯＰＬＬ）症的诊断和治疗方法。方法：报告１３例ＴＯＰＬＬ患者发病情况,临床表现、Ｘ线征、ＣＴ、ＭＲＩ检查及治疗情况。结果：经休守治疗,１３例均效果不佳。１０例行手术治疗。后路椎板切除减压５例,３例症状改善,１例部分恢复,１例加重;后路椎板切除加骨化韧带切除１例,术后症状加重;侧前方入路３例,２例症状恢复,１例部分恢复。１例作环状减压术后完全恢复。结论：ＣＴ、ＭＲ     

颈椎前路V形截骨Y形减压融合术治疗后纵韧带骨化症的临床疗效观察

【摘要】 目的：观察颈椎前路V形截骨Y形减压融合术（anterior cervical V-osteotomy Y-decompression and fusion,ACVYF）治疗颈椎后纵韧带骨化症的临床疗效。方法：回顾性分析2018年6月~2022年10月在河南省洛阳正骨医院行手术治疗的60例单节段椎体层面后纵韧带骨化症患者的临床资料,其中30例采用ACVYF治疗（ACVYF组）,男18例,女12例;年龄47~65岁（61.0±6.4岁）,体质指数16.8~28.1kg/m2（23.67±2.86kg/m2）;病程10~80个月（37.5±20.1个月）;手术节段：C3 2例、C4 5例、C5 13例、C6 10例。30例采用颈前路椎体次全切除减压融合术（anterior cervical corpectomy decompression and fusion,ACCF）治疗（ACCF组）,男19例,女11例;年龄44~68岁（59.5±6.8岁）;体质指数16.6~26.4kg/m2（23.30±2.56kg/m2）;病程13~72个月（35.8±18.8个月）;手术节段：C3 3例、C4 6例、C5 12例、C6 9例。两组性别、年龄、体质指数、病程、手术节段等一般资料比较无统计学差异（P>0.05）,具有可比性。比较两组手术时间、术中出血量、并发症;术前和术后1周、3个月、6个月、12个月进行颈椎日本骨科协会（Japanese Orthopaedic Association,JOA）评分,计算术后12个月时的JOA评分改善率;术前和术后1周、3个月、6个月和12个月在X线片上测量融合区高度、C2~7 Cobb角;术后3个月、6个月和12个月时在X线片或CT片上观察植骨融合情况。结果：两组患者均顺利完成手术, ACVYF组手术时间为88.2±19.7min,术中出血量为133.3±24.4mL;ACCF组手术时间为91.5+24.1min,术中出血量为137.7±29.4mL,两组手术时间和术中出血量比较均无统计学差异（P>0.05）。ACVYF组与ACCF组术后各有3例患者发生吞咽困难,1~2周后均自行缓解,随访期间无其他并发症发生,两组并发症发生率无统计学差异（P>0.05）。两组术后各时间点颈椎JOA评分与术前比较均有显著性改善（P<0.05）,两组间同时间点比较均无统计学差异（P>0.05）;两组术后各时间点融合区高度和C2~7 Cobb角与术前比较均有统计学差异（P<0.05）,术前、术后1周和术后3个月两组间比较均无统计学差异（P>0.05）,术后6个月和术后12个月ACVYF组均大于ACCF组（P<0.05）。术后12个月随访时ACVYF组颈椎JOA评分改善率为（72.39±10.54）%,ACCF组术为（75.92±10.39）%,两组比较无统计学差异（P>0.05）。ACVYF组术后3个月与6个月随访时植骨融合率（70.0%和93.3%）优于ACCF组（40.0%和73.3%）（P<0.05）,术后12个月两组均已骨性融合（P>0.05）。结论：ACVYF能有效解除椎体层面后纵韧带对脊髓的压迫,改善患者神经功能;相较于ACCF,ACVYF能够更好地维持颈椎生理曲度,加快植骨融合。     

胸椎后纵韧带骨化症的诊断与治疗

报告９例胸椎后纵韧带骨化症，年龄自４７～６８岁，平均５５岁。除１例位于Ｔ１０～１１水平外均发生在上、中胸椎。本文讨论了本症的发病率、临床表现、影像学特征以及手术方法。指出经肋横突椎弓根入路、前入路骨化韧带切除为本病的主要术式     

椎体次全切除植骨融合治疗颈椎后纵韧带骨化症

目的：分析椎体次全切除植骨融合术治疗颈椎后纵韧带骨化症。方法：75例患者，男45例，女30例；年龄42～64岁，平均51.6岁。病变累及1个椎节者29例，2个椎节者39例；3个椎节者7例。椎体次全切除提供向侧方低达椎弓根前内缘的减压骨槽，其底宽一般为18～20mm，使椎管前壁近乎完全敞开。直视下切除骨化的后纵韧带。强调牵引下植骨。按JOA评分和X线片，判定改善率和植骨区骨性融合。结果：75例中有68例获3个月～6年2个月（平均2年7个月）的随访。X线片示：切除1或2个椎节者，术后3～4个月植骨区骨性融合；而切除3个椎节者，5～6个月获骨性融合。优良率85.3%，改善率3.4%～91.3%，平均70.8%。3例并发短期C5或C6神经根麻痹，2例并发硬脊膜损伤，无脊髓和椎动脉等损伤并发症。结论：椎体次全切除术使椎管前壁近乎完全敞开，给切除骨化的后纵韧带提供足够大的视野条件，使减压更趋完善。     

颈椎病合并颈椎后纵韧带骨化症的前路手术治疗

目的 探讨颈椎病合并颈椎后纵韧带骨化症(OPLL)前路切除减压的方法及其临床效果.方法采用颈椎前路减压治疗颈椎病合并颈椎OPLL患者61例,其中男42例,女19例,平均57岁(45～74岁).术前明确诊断颈椎病合并OPLL者49例,术中发现合并有OPLL者12例.OPLL椎管狭窄率32%～70%,平均52%.神经功能JOA评分术前4～14分,平均9.6分.手术在常规颈前路经椎间隙或椎体次全切除减压的基础上,切除骨化后纵韧带彻底减压.结果 本组41例患者采用前路椎体次全切除减压,6例经椎间隙扩大减压,14例采用椎体次全切除结合经椎间隙减压的手术方式.所有患者随访6个月～3年,平均16个月.术后JOA评分8～16分,平均12.8分,神经功能恢复率25.0%～87.5%,平均65.2%.5例患者术后并发脑脊液漏,经保守治疗后均获得痊愈,无1例出现脊髓功能损害加重.结论 颈椎病合并颈椎OPLL增加了手术难度和风险,在颈椎前路常规减压的基础上再将骨化的后纵韧带切除,保证了前路减压的彻底性,可提高手术治疗效果.     

Two-staged decompression for thoracic paraparesis due to the combined ossification of the posterior longitudinal ligament and the ligamentum flavum: a case report

Study design A case report of ossification of the posterior longitudinal ligament (OPLL) combined with ossification of the ligamentum flavum, or yellow ligament (OYL), in the upper thoracic spine. Objective To describe a rare clinical entity and its management pitfalls in a patient with upper thoracic myelopathy due to combined OPLL and OYL. Methods A 52-year-old woman developed paresthesia and paraparesis of both legs. One month prior to admission she fell and became unable to walk. She was diagnosed as having upper thoracic myelopathy due to combined OPLL and OYL and was treated by two-stage anterior and posterior spinal decompression. Posterior decompression was achieved first by laminoplasty at C3–Th1 and laminectomy of Th2 and Th3. Results After posterior decompression, her symptoms immediately and dramatically improved. However, symptoms recurred after she was able to achieve a sitting or standing position. We then performed anterior decompression at Th2, which again improved her symptoms. At two years post-surgery, she is ambulatory with the use of a cane. Conclusion Upper thoracic myelopathy due to OPLL and OYL was treated by combined 2-staged anterior and posterior decompression. In this case, posterior decompression alone was inadequate to relieve the symptoms of this pathological condition.     

Posterior decompression with instrumented fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament

We evaluated the clinical results of posterior decompression with instrumented fusion (PDF) for thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL). A total of 24 patients underwent PDF, and their surgical outcomes were evaluated by the Japanese Orthopaedic Association (JOA) scores (0–11 points) and by recovery rates calculated at 3, 6, 9 and 12 months after surgery and at a mean final follow-up of 4 years and 5 months. The mean JOA score before surgery was 3.7 points. Although transient paralysis occurred immediately after surgery in one patient (3.8%), all patients showed neurological recovery at the final follow-up with a mean JOA score of 8.0 points and a mean recovery rate of 58.1%. The mean recovery rate at 3, 6, 9 and 12 months after surgery was 36.7, 48.8, 54.0 and 56.8%, respectively. The median time point that the JOA score reached its peak value was 9 months after surgery. No patient chose additional anterior decompression surgery via thoracotomy. The present findings demonstrate that despite persistent anterior impingement of the spinal cord by residual OPLL, PDF can result in considerable neurological recovery with a low risk of postoperative paralysis. Since neurological recovery progresses slowly after PDF, we suggest that additional anterior decompression surgery is not desirable during the early stage of recovery.     

Familial ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine: case report

BACKGROUND

Ossification of the posterior longitudinal ligament (OPLL) of the spine is most common in the Japanese population and in the cervical spine. We present a case of OPLL of the lower thoracic spine in two Caucasian siblings.

CASE DESCRIPTION

A 58-year-old female presented with lower extremity dysesthesia and urinary hesitancy. Family history was significant for a brother who had OPLL of the lower thoracic spine removed surgically. Magnetic resonance imaging and computed tomography scan of the thoracic spine demonstrated OPLL at T10–11 causing cord compression and abnormally high T2 signal in the cord. The patient underwent posterior decompression with improvement of her symptoms.

CONCLUSION

A genetic predisposition to develop OPLL has been suggested by previous linkage and biochemical studies. While OPLL is an increasingly recognized diagnosis in North America, this is the first reported case of familial thoracic OPLL in Caucasian siblings.     

颈椎后纵韧带骨化症的手术治疗及疗效分析

[目的] 探讨颈椎后纵韧带骨化症（OPLL）手术治疗方法、疗效及其并发症。[方法] 对本组自2000年以来手术治疗的48例OPLL患者的临床资料进行回顾性总结分析。其中前路手术18例，后路手术30例，按照JOA评分标准判定其术后改善率，对患者术前术后X线、CT及MRI影像学资料进行比较分析，并统计手术并发症。[结果] 48例患者中合并原发性椎管狭窄23例，平均椎管狭窄率41．4％，术前MRI示脊髓信号改变者19例；前路手术平均改善率68．3％，后路手术平均改善率51．3％；术后并发脑脊液漏2例，节段性神经根麻痹5例，血肿2例。[结论] 应根据后纵韧带骨化部位、范围及椎管狭窄率选择合适手术方法，方能减少并发症，提高手术疗效。     

胸椎后纵韧带骨化的临床特点及治疗策略

目的回顾研究手术治疗胸椎后纵韧带骨化症(OPLL)的临床特点及治疗方法。方法1991至2005年手术治疗胸椎OPLL55例,男19例,女36例;年龄35～73岁,平均51.9岁。均伴有脊髓损害。手术方式包括单纯椎管后壁切除术34例、前方OPLL切除减压术15例以及前后路联合手术6例。结果55例中36例(65.5%)合并胸椎黄韧带骨化(OLF),18例(32.7%)合并颈椎OPLL。单纯发生于上胸椎的OPLL13例(23.6%),中胸椎12例(21.8%),下胸椎及胸腰段17例(30.9%),广泛分布者13例(23.6%)。43例获得随访,平均随访时间47.1个月(6～168个月)。37例神经功能有改善,改善率为76.6%,无改善2例,加重4例。前方入路获随访者13例,其中3例症状加重,余改善率平均为82.9%(42.9%～100%)。后路椎管后壁切除术获随访者25例,1例无改善,1例加重,余改善率平均为72.6%(22.2%～100%)。前后路联合手术获随访5例,1例无改善,余改善率平均为83.9%。结论胸椎OPLL常合并胸椎OLF及颈椎OPLL。上胸椎OPLL合并颈椎管狭窄可一期行颈后路单开门及上胸椎椎管后壁切除术。两个节段以内的OPLL且不合并有造成脊髓压迫的胸椎OLF可行前路OPLL切除减压术,否则行后路椎管后壁切除术。单节段的OPLL合并胸椎OLF可行前后路联合手术。     

前路飘浮法治疗颈椎后纵韧带骨化症初步报告

目的 :对前路飘浮法治疗颈椎后纵韧带骨化症 (OPLL)手术疗效进行初步评析。方法 :对 16例颈椎O PLL患者行前路飘浮法治疗 ,其中连续型 3例 ,节段型 8例 ,混合型 3例 ,孤立型 2例 ;最长手术节段 3节 ;椎管狭窄率 3 0 %～ 70 %。所有患者均采用钛板、钛网行颈椎重建。术后对近期结果随访 ,并按日本矫形外科协会 (JOA)评分系统评分。结果 :平均随访时间 6个月 ,平均恢复率为 68 2 %。无脑脊液漏、神经损伤等并发症发生。颈椎融合良好。结论 :前路飘浮法适合于大多数OPLL患者 ;新型颈椎内固定系统扩大了前路OPLL手术适应证     

胸椎后纵韧带骨化致椎管狭窄症的临床特征和手术治疗方法

目的 探讨胸椎后纵韧带骨化致椎管狭窄症的临床特征和手术治疗方法.方法 2004年1月至2009年3月,手术治疗胸椎后纵韧带骨化致椎管狭窄症患者21例,男13例,女8例;年龄34～71岁,平均51.2岁;病程2～50个月,平均11个月.病变位于上胸段(T1～T4)4例,中胸段(T5～T8)7例,下胸段(T9～T12)10例;合并黄韧带骨化9例,合并颈椎后纵韧带骨化8例.11例行后路椎板切除术,10例行侧前方减压术.结果 后路椎板切除手术时间90～240 min,平均140 min.侧前方减压手术时间110～360min,平均240min.术后患者症状未加重,未出现神经系统并发症、无蛛网膜下腔感染和伤口感染.术后6个月日本骨科协会(Japanese Orthopaedic Association,JOA)评分为8～15分,平均(9.17±1.63)分;其中神经功能改善率8例为优,6例为良,5例为可,2例为差,优良率为66.7%.术后12个月JOA评分为8～15分,平均(10.23±1.64)分;其中神经功能改善率8例为优,7例为良,4例为可,2例为差,优良率为71.4%.结论 胸椎后纵韧带骨化致椎管狭窄临床表现多样,常合并颈椎后纵韧带骨化和黄韧带骨化,后路椎板切除术和侧前方减压术有较好疗效.     

Indirect posterior decompression with corrective fusion for ossification of the posterior longitudinal ligament of the thoracic spine: is it possible to predict the surgical results?

To investigation of the outcomes of indirect posterior decompression with corrective fusion for myelopathy associated with thoracic ossification of the longitudinal ligament, and prognostic factors. Conservative treatment for myelopathy associated with thoracic ossification of the longitudinal ligament (OPLL) is mostly ineffective, and treatment is necessary. However, many authors have reported poor surgical outcomes, and no standard surgical procedure has been established. We have been performing indirect spinal cord decompression by posterior laminectomy and simultaneous corrective fusion of the thoracic kyphosis. Twenty patients underwent indirect posterior decompression with corrective fusion, and were included in this study. The follow-up period was minimum 2 years and averaged 2 years and 9 months (2–5 years 6 months). Operative results were examined using JOA scoring system (full marks: 11 points) and Hirabayashi’s recovery rate, as excellent (100–75%), good (74–50%), fair (49–25%), unchanged (24–0%) and deteriorated (i.e., decrease in score less than 0%). Cases in which the spinal cord is floating from OPLL on intraoperative ultrasonography were defined as the floating (+) group, and those without floating as the floating (−) group. In addition, we used compound muscle action potentials (CMAP) as intraoperative spinal cord monitoring and the cases were divided into three groups: Group A, no change in potential; Group B, potential decreased, and Group C, potential improved. The mean pre- and postoperative JOA scores were 6.2 and 8.9 points, respectively, and the recovery rate was 56%. The outcome was rated excellent in three, good in eight, fair in six, unchanged in two, and deteriorated in one. The mean preoperative thoracic kyphosis measured 58°, and was corrected to 51° after surgery. On intraoperative ultrasonography, 12 cases were included in the floating (+) and 8 in the floating (−) groups; the recovery rates were 58 and 52%, respectively, showing no significant difference between the recovery rates of the two groups. Regarding intraoperative CMAP, the outcome was excellent in one, good in seven, fair in four, and unchanged in one in Group A; fair in one, unchanged in one, and deteriorated in one in Group B, and excellent in two and good in one in Group C. The recovery rates were 50, 48 and 68.3% in Groups A, B and C, respectively, showing that the postoperative outcome was significantly poorer in Group B. Although indirect posterior decompression with corrective fusion using instruments obtained satisfactory outcomes, not all cases achieved good outcomes using this procedure. We consider that additional application of anterior decompressive fusion is preferable when improvement of symptoms occurs not satisfactory after indirect posterior decompression with corrective fusion using instruments. Intraoperative spinal cord monitoring of CMAP demonstrated that the spinal cord was already impaired during the laminectomy via the posterior approach. Concomitant intraoperative monitoring of CMAP to avoid impairment of the vulnerable spinal cord and corrective posterior spinal fusion with indirect spinal cord decompression is recommendable as a method capable of preventing postoperative neurological aggravation.     

后路环形减压术治疗胸椎后纵韧带骨化症术后脑脊液漏的危险因素分析

目的:回顾性分析后路经关节突脊髓环形减压术治疗胸椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)发生术后脑脊液漏(cerebrospinal fluid leakage,CSFL)的相关危险因素.方法:2015年8月～2019年12月,共有50...