“单开门”揭开式椎板整块切除、椎弓根螺钉固定治疗极重度颈椎后纵韧带骨化症

 目的 观察“单开门”揭开式椎板整块切除、椎弓根螺钉固定治疗极重度颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament， OPLL)的临床疗效。方法 回顾性分析2007年1月至2011年12月治疗极重度颈椎OPLL 16例患者资料，男13例，女3例；年龄45~74岁，平均56.5岁。15例神经功能损害与头颈部活动有关(如打喷嚏、咳嗽、过伸颈部等)，1例诱因不明，神经症状均持续加重。术前日本矫形外科协会评分(Japanese Orthopaedic Score, JOA)为(7.1±1.8)分。术前CT扫描示骨化的后纵韧带平均占椎管矢状径的83.7％。患者均接受后路椎板整块切除、颈椎弓根螺钉固定手术。结果 手术时间为80~150 min，平均130 min；出血量为150~600 ml，平均300 ml。16例患者均获得随访，随访时间为3个月至4年，平均(24.4±10)个月，术后2周、3个月、末次随访平均JOA评分为(13.2±1.7)分、(13.5±1.6)分、(14.1±1.5)分， JOA评分改善率分别为61.6%、64.6%、70.7%。术后1例伤口形成血肿，1例发生脑脊液漏，3例肩背部疼痛。术中、术后未见深部感染、神经功能恶化、椎动脉损伤、内固定失败等严重并发症。结论 颈椎“单开门”揭开式椎板整块切除术对脊髓干扰小、安全性高，结合颈椎弓根螺钉固定能够稳定减压节段，维持颈椎曲度，可用于重度颈椎OPLL合并颈脊髓损伤患者的治疗。

En bloc open-door laminectomy and pedicle screw fixation for extremely severe cervical ossification of posterior longitudinal ligament

Objective To evaluate the effect of en bloc open-door laminectomy and pedicle screw fixation for extremely severe cervical ossification of posterior longitudinal ligament (OPLL). Methods From January 2007 to December 2011, 16 cases of serious cervical OPLL were treated, in which there were 13 males and 3 females, aged from 45 to 74 years (average, 56.5 years). Spinal cord functional deterioration was related to minor activities of the neck, such as sneeze, cough or hyperextension of the neck, in 15 cases. One case suffered from aggravating neurological symptoms without a definite precipitating factor. The average preoperative Japanese Orthopaedic Score (JOA) was 7.1±1.8. Preoperative CT scans displayed the average stenotic rate (thickness of OPLL/sagittal diameter of the spinal canal) was 83.7%. All the patients received en bloc laminectomy and pedicle screw fixation of the cervical spine. Results All the patients were followed up for 3 months to 4 years (average, 24.4±10 months). The JOA scores at 2 weeks, 3 months, and the last follow-up postoperatively were 13.2±1.7, 13.5±1.6 and 14.1±1.5, respectively; the improvement rates were 61.6%, 64.6% and 70.7%, respectively. The operative time ranged from 80 to 150 minutes (average, 130 minutes), and blood loss ranged from 150 to 600 ml (range, 300 ml). One case of postoperative wound hematoma, 1 case of cerebrospinal fluid leakage and 3 cases of trapezius muscle pain occurred in this group. No serious complications, such as deep infection, deterioration of neurological dysfunction, vertebral artery injury and internal fixation failure, were noticed. Conclusion Owing to the minimum interference to the cervical spinal cord, stabilization of the decompressed segments and maintenance of cervical lordosis, en bloc open-door laminectomy and pedicle screw fixation is suitable for extremely severe cervical OPLL.