手术治疗颈椎后纵韧带骨化症的效果及影响因素

目的:探讨手术治疗颈椎后纵韧带骨化症(OPLL)的疗效及其影响因素.方法:2000年4月～2006年4月在我院接受手术治疗并得到随访的颈椎OPLL患者共53例,男性36例,女性17例.术前JOA评分3-12分,平均8.5±3.1分.神经症状出现时间2～81周,平均27.4±15.6周.选择术前压迫最重节段CT层面测量发育椎管面积、骨化韧带面积,计算出脊髓受压比率(骨化韧带面积/发育椎管面积),随访时测量同节段椎管扩大比率.30例采用单纯后路手术,13例行一期前后路手术,4例先行后路再行前路手术,6例单纯行前路减压.利用统计学分析软件SPSS 12.0将脊髓受压比率、术前JOA评分、手术后椎管扩大比率、手术方式选择、患者年龄、神经症状出现时间等因素与手术后JOA评分改善率进行多元相关分析.结果:随访29～101个月,平均46±16个月,术后1年JOA评分改善率为30%～72%,平均53.1%±11.4%,末次随访时JOA评分改善率为28%～68%,平均52.8%±10.5%;脊髓受压比率、术前JOA评分、手术时患者年龄与手术后JOA评分改善率之间存在相关关系,手术入路、症状持续时间、手术后椎管扩大比率与疗效无显著相关关系.结论:选择恰当的术式手术治疗颈椎后纵韧带骨化症可取得较满意的临床效果,脊髓受压严重程度、患者年龄和术前神经功能状态与疗效有相关关系.

Outcome of surgical treatment for ossification of posterior longitudinal ligament of cervical spine and its influencing factor

Objective:To study the result and the influencing factors of the surgical treatment for ossification of posterior longitudinal ligament(OPLL) of cervical spine.Method:From April 2000 to April 2006,53 OPLL patients underwent surgical treatment and were followed up.There were 36 males and 17 females with an av-erage age of 62.3±8.4 years at the time of surgery.Tbe preoperative JOA score was 8.5±3.1 (range,3～12).The duration of the symptoms was 27.4±15.6 weeks (range,2-81 weeks ).Complications included diabetes in 32 cases,old-cerebrovascular disease in 8 eases,old-heart infarction in 8 cases and hypertension in 8 cases.Be- fore operation,the area of the developed vertebral canal and OPLL at the CT layer of the cervical segment compressed mostly was measured,and the ratio of the compreesed spinal cord(area of OPLL/area of developed vertebral canal) was calculated.The enlargement ratio of the vertebral canal at the same layer was measured at the time of following up.The expansive open-door laminoplasty was performed for 30 patients,one staged anterior and posterior approach for 14 patients,3 patients underwent posterior approach first and then delayed anterior approach,6 patients underwent anterior decompression and fusion with internal fixation.The relationship between postoperative JOA recovery rate and the ratio of the compressed spinal cord,preoperative JOA score,the age of patients,duration of symptoms,approach and dura enlargement ratio was analyzed by using statistics software SPSS 12.0.Correlation eoeffient was calculated and the factors related to outcome was obtained.Re-suit:The follow up time was 29～101 months with an average of 46±16 months.JOA recovery rate was 52.8%±10.5%(range,30%～72%) one year after the operation,and 52.8%±10.5%(range,28%-68%) at last follow-up.The ratio of the compressed spinal eord,prcoperative JOA score,the age of patient at the time of operation were associated with postoperative recovery rate.However,the approaeh,durntion of symptoms,vertebral canal enlargement ratio had no significant relationship with postoperative recovery rate.Conclusion:Surgical treatment for OPLL of cervical spine can provide a satisfied result when an appropriate approach is selected.The severi-ty of compressed spinal cord,age of patient and the condition of preoperative neurofunction are related to theoutcomes.