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。

Cervical Ossification of Posterior Longitudinal Ligament Treated by Subtotal Vertebrectomy with Fusion

Objective: To analyze follow up results on anterior subtotal vertebrectomy and fusion for cervical ossification of posterior longitudinal ligament.Methods:75 patients were treated by this procedure.There were 45 males and 30 females.The age of the patients ranged from 42 to 64 (average 51.6).29 patients underwent one vertebral subtotal vertebrectomy with fusion,39 two vertebral subtotal vertebrectomy with fusion,7 three vertebral subtotal vertebrectomy with fusion.An electric drill with a 5mm burr was used to drill a trench 18 to 20 mm in width through the medial portion of the involved vertebral bodies.The base of decompressive trench should reach the anteromedial parts of the pedicles.The ossification of posterior longitudinal ligament was removed in direct view.The graft is inserted and impacted with the proper position under manual traction on the neck.The rate of recovery was assessed according to JOA Score System.Bone union of the graft was decided according to the posteroanterior and lateral roentgenogram.Result:68 of the 75 patients operated on have been followed up for a mean period of 31 months(range 3 to 74 months).In the one vertebral subtotal vertebrectomy and the two vertebral subtotal vertebrectomy groups,interbody fusion was gained about 3 to 4 months after operation.In the three vertebral subtotal vertebrectomy group,about 5 to 6 months after operation.The excellent and good rate was 85.3% and mean recovery rate was 70.8%.Conclusion:Subtotal vertebrectomy with fusion provided spacious and clear operation field and excellent exposure was of paramount importance for excision of ossified postetrior longitudinal ligament,so that decompression of spinal cord tended to be perfect.