颈椎管单开门扩大成形辅助椎弓根钉棒固定术后轴性痛诱因探讨

 目的 探讨多节段颈椎后纵韧带骨化症(cervical ossification of posterior longitudinal ligament, OPLL)患者,行颈椎管后路单开门扩大成形辅助椎弓根钉棒系统固定术后轴性痛(postoperative axial pain, PAP)发作诱因,以及对短期临床疗效的影响。方法 回顾性分析2007-01至2010-06,于武警后勤学院附属医院因多节段OPLL行后路单开门扩大成形减压,联合连续节段双侧椎弓根钉棒固定患者106例,至少随访3年,比较PAP组和非PAP组间术前合并颈椎不稳比例、术后较术前椎管正中矢径、椎板开门角、Pavlov比值、硬膜囊横截面积、颈椎生理曲度、颈髓后移距离、术后3个月JOA评分矫正值差异。结果 19例PAP患者首发时VAS2分者10例,2.5分5例,3分3例,3.5分1例,经非手术治疗后于术后3.7～10.9个月缓解,PAP组术前合并颈椎短节段不稳比例高于非PAP组,差异有统计学意义(χ²=3.89,P=0.04);PAP和非PAP两组间术后3个月较术前JOA评分矫正值差异无统计学意义(t=107.20,P=0.22),其他观测参数亦均无显著统计学差异。结论 多节段OPLL患者术前合并颈椎单节段不稳时更易诱发PAP发生,未对术后早期疗效和神经功能改善程度造成负面持续影响。

Etiology of postoperative axial pain after cervical unilateral laminoplasty combined with pedicle fixation

Objective To investigate the etiology and influence of postoperative axial pain among patients with multilevel ossification of cervical posterior longitudinal ligament(OPLL) after unilaterally expansive laminoplasty fixed with pedicle screws and rods.Methods This study retrospectively reviewed 106 OPLL patients who had undergone unilaterally expansive laminoplasty supplemented by successive bilateral pedicle fixation with a minimum of 36 months of follow-up.The proportion of preoperative single-level unsteadiness, postoperative corrected values of canal mid-sagittal diameter,open-laminar angle,Pavlov ratio,cross-sectional area of dural sac,physical curvature,drift-back distance,and Japanese Orthopaedic Assoaiation Scale JOA recovery amplitude at postoperative 3 months were compared between the PAP group and the non-PAP group.Results In term of Visual Analogue Scale(VAS) of initial onset,PAP patients were composed of ten cases of grade 2,five cases of grade 2.5, three cases of grade 3, and one case of grade 3.5.Their symptoms were relieved via conservative treatment within 3.7 to 10.9 months.The rate of short-segment instability before surgery in the PAP group was higher than that in the non-PAP group,and the difference was of statistic significance. The OA score in PAP group improved as much as in the non-PAP group,but there was statistically significant difference.The other observed parameters were not significantly different.Conclusions Multilevel OPLL patients are more vulnerable to PAP if preoperative cervical short-level instability occurs.The occurrence of PAP will not negatively affect early efficacy and rehabilitation of neurologic function after operation.