改良椎板整块切除结合钉棒系统内固定术治疗颈椎后纵韧带骨化症

目的观察改良椎板整块切除结合钉棒系统内固定治疗颈椎后纵韧带骨化症（OPLL）的效果。方法收集20例颈椎OPLL患者的资料,均接受改良椎板整块切除结合钉棒系统内固定术;术前CT扫描示骨化的后纵韧带平均占椎管矢径的53.9%（狭窄率）。比较手术前后的日本矫形外科协会评分（JOA）评分,观察并发症发生情况。结果 20例患者术后均获得6个月-3年的随访,平均（26.5±8）个月;术后1周、3个月、6个月JOA评分分别为（12.4±1.4）、（13.5±1.2）、（14.2±1.6）分,较术前（8.5±1.1）分均明显升高（P〈0.01）。术后出现浅表感染1例、脑脊液泄漏2例、颈椎轴性症状3例,未见颅内感染、椎动脉破裂等严重致死性并发症。结论改良椎板整块切除结合钉棒系统内固定治疗颈椎OPLL能够最大限度地减少手术对颈髓的干扰,且减压充分,能够重新恢复颈椎的稳定性、保持正常生理曲度,是治疗颈椎OPLL的有效方法 。

Improved Laminectomy Combined with Screw-Rod Fixation for Ossification of Posterior Longitudinal Ligament

Objective To observe the efficacy of improved laminectomy combined with screw-rod fixation in the treatment of ossification of posterior longitudinal ligament（OPLL）. Methods Data of 20 patients who received improved laminectomy and screw-rod fixation for OPLL were retrospectively analyzed. Before operation, CT scan showed that the ossific posterior longitudinal ligament accounted for53.9% of the sedation radius vector（stenosis rate）. Japanese Orthopedic Association（JOA） scores were compared before and after operation. In addition, complications were observed. Results Patients were followed up for an average of（26.5±8） months（range, 6-36 months）. Before operation JOA Scores was（18.5±1.1）,JOA scores were（12.4 ±1.4）,（13.5±1.2） and（14.2±1.6） at 1 week, 3 months and 6 months after operation, respectively. The JOA scores increased significantly after operation（P0.01）. Among the20 patients, postoperative superficial infection occurred in 1, cerebrospinal fluid leak in 2, and cervical axial symptoms in 3. No intracranial infection, vertebral artery rupture and other serious complications were found in all patients. Conclusion Improved laminectomy combined with screw-rod fixation can effectively minimize the interference of surgery for cervical spinal, ensure the sufficient decompression,restore the stability of cervical spine and maintain the normal physiological curvature in the treatment of cervical OPLL.