伴交感神经症状的脊髓型颈椎病前路手术中切除后纵韧带的早期疗效研究

 目的 探讨颈前路人工颈椎间盘置换手术及融合手术中是否去除后纵韧带对治疗伴交感神经症状的脊髓型颈椎病早期疗效的影响。方法 2005年1月至2011年7月，57例伴交感神经症状的脊髓型颈椎病患者分别接受人工颈椎间盘置换手术(置换组，21例)或颈前路减压植骨融合内固定手术(融合组，36例)；每组再依据术中是否去除后纵韧带分为去除组(置换去除组，13例；融合去除组，23例)和保留组(置换保留组，8例；融合保留组，13例)。分别在术前、术后第9　天、3、6及12个月评价患者的交感神经症状(20分评分法评估)改善情况、日本矫形外科协会评分(Japanese Orthopedic Association, JOA)、健康调查生活质量量表(the MOS item short from health survey， SF-36)、人工椎间盘假体及植骨融合的稳定性。结果　无论采用颈椎间盘置换还是融合手术，术中是否去除后纵韧带，患者的交感神经症状评分、JOA评分、SF-36评分等术后均较术前有明显改善。融合成功率为100%；人工椎间盘假体位置稳定，未见松动、移位。无论是采用颈椎间盘置换手术还是融合手术，术中去除后纵韧带患者的手术疗效优于保留后纵韧带者。结论 无论采用人工颈椎间盘置换还是融合手术治疗伴交感神经症状的脊髓型颈椎病，术中去除后纵韧带较保留后纵韧带可使患者症状得到更好地缓解，早期效果更好。

Early clinical effect of resecting posterior longitudinal ligam ent in anterior approach for cervical spondylotic myelopathy with sympathetic symptoms

Objective To investigate the effect of resecting posterior longitudinal ligament (PLL) in cervical artificial disc replacement or anterior cervical decompression and fusion (ACDF) for cervical spondylotic myelopathy with sympathetic symptoms on early clinical outcome. Methodｓ From January 2005 to July 2011, 57 patients with cervical spondylotic myelopathy combined with sympathetic symptoms were divided into two groups: group A in which patients underwent cervical artificial disc replacement (21 patients) and group B in which patients underwent ACDF (36 patients). According to whether the PLL was resected, each group was divided into two subgroups: resecting group (group A: 13 patients and group B: 23 patients) and nonresecting group (group A: 8 patients and group B: 13 patients). Clinical and radiologic conditions were evaluated preoperatively, 9 days, 3 months, 6 months and 12 months postoperatively. The 20-point system was used to evaluate the sympathetic symptoms, and the Japanese Orthopedic Association (JOA) score and the MOS item short from health survey(SF-36) were employed to evaluate the clinical outcomes. Results The 20-point system score, JOA score, and SF-36 score were significantly improved in all patients after surgery, and no matter group A and group B, the clinical outcomes in resecting group were better than those in nonresecting group. No loosening and displacement of prosthesis occurred. Conclusion In cervical artificial disc replacement or ACDF for cervical spondylotic myelopathy with sympathetic symptoms, resecting the PLL can provide better early clinical effect.