后路椎板成形术治疗颈椎后纵韧带骨化症的疗效及影响因素分析

目的探讨后路椎板成形术治疗颈椎后纵韧带骨化症(OPLL)的疗效,并对疗效的影响因素进行分析。方法选择行后路椎板成形术的60例颈椎OPLL患者进行回顾性分析,通过对患者影像学及神经学评估来比较术前及术后5年的临床疗效结果 ,并且分析年龄、性别、术前椎管狭窄率及骨化外形对手术疗效的影响。结果 60例患者术后5年随访时骨化程度和脊髓有效容积(SAC)、日本矫形协会(JOA)评分、椎管狭窄率、颈椎曲度前凸百分率与术前比较,差异均有统计学意义(t分别=8.89、17.28、5.79,χ2=5.00,P均<0.05);不同年龄(年龄<60岁&≥60岁)及不同骨化外形(平原型&山形)的患者术后5年随访时的SAC、JOA评分和椎管狭窄率比较,差异均有统计学意义(t分别=3.53、3.63、3.95、5.00、6.82、2.67,P均<0.05),但是颈椎曲度前凸的百分率比较,差异无统计学意义(χ2=0.57、0.97,P均>0.05);不同的术前椎管狭窄率(<60%&≥60%)的患者术后5年随访时的SAC、JOA评分比较,差异均有统计学意义(t分别=10.27、6.86,P均<0.05),但是颈椎曲度前凸的百分率比较,差异无统计学意义(χ2=0.02,P>0.05);不同性别患者在术后5年随访时的SAC、JOA评分、椎管狭窄率、颈椎曲度前凸的百分率比较,差异均无统计学意义(t分别=0.67、0.15、0.12,χ2=0.02,P均>0.05)。结论后路椎板成形术对颈椎OPLL患者有明显疗效,其中椎板成形术对术前年龄<60岁、椎管狭窄率<60%以及骨化外形为平原型的患者中疗效较好。

Effect and the factor analysis of posterior laminoplasty in treatment of ossification of posterior longitudinal liga-ment

Objectives To discuss the effect of posterior laminoplasty in treatment of ossification of the posterior longitu-dinal ligament and analyse the influencing factors. Methods Sixty patients with ossification of the posterior longitudinal ligament who received posterior laminoplasty were analyzed retrospectively. The clinical effects of preoperative and 5 years after postoperative were evaluated and compared by the imageology and neurology, and age, gender, spinal stenosis rate and shape of ossification that influenced clinical effect were analyzed. Results Compared with preoperative, the ossifica-tion degree, space available for the cord（SAC）, score of Japanese orthopedic association（JOA）, spinal stenosis rate and lordosis rate of cervical curvature at postoperative were significantly different （t=8.89,17.28,5.79,χ^25.00,P〈0.05）. The SAC, score of JOA and spinal stenosis rate were significantly different among different age and different shape of ossifica-tion（t=3.53,3.63,3.95,5.00,6.82,2.67,P〈0.05） while the lordosis rate of cervical curvature were not significantly differ-ent（χ^20.57,0.97,P〉0.05）. The SAC, score of JOA were significantly different between different spinal stenosis rate at 5 years after postoperative（t=10.27,6.86,P〈0.05） while the lordosis rate of cervical curvature was not significantly different （χ^20.02,P〉0.05）. The SAC, score of JOA and spinal stenosis rate were significantly different between male and female at 5 years after postoperative （t=0.67, 0.15, 0.12,χ^20.02,P〉0.05）. Conclusions Posterior laminoplasty is effective to treat OPLL, especially suitable for patients whose age〉60, spinal stenosis rate〉60%and plateau-shaped of ossification.