两种不同术式治疗合并颈椎后纵韧带骨化的重度脊髓型颈椎病疗效分析

目的探讨前路、后-前联合入路两种不同术式治疗合并颈椎后纵韧带骨化(Ossificationof posterior longitudinal ligament,OPLL)的重度脊髓型颈椎病的适应证及临床疗效。方法对38例合并颈椎OPLL的重度脊髓型颈椎病患者分别行颈椎前路手术(A组,22例)和后-前联合入路手术(B组,16例)。比较两组患者椎管狭窄率、骨化节段及脊髓压迫率的差异,并根据术前及术后随访时的JOA评分,评价两组患者的神经功能恢复情况。结果所有病例随访12～30个月,平均20个月,术中未出现脊髓、椎动脉损伤等严重并发症,两组脊髓功能均获不同程度改善。A组JOA评分从术前平均(7.9+2.1)分提高至术后1年平均(13.1+1.7)分,平均改善率为(65.9+5.2)%;B组JOA评分从术前平均(6.8+1.6)分提高至术后1年平均(13.9+0.9)分,平均改善率为(69.8+4.5)%,对比两组患者疗效无统计学差异(P>0.05)。结论采用前路或后-前联合入路治疗合并颈椎OPLL的重度脊髓型颈椎病,均取得彻底的椎管减压和良好的临床疗效,根据脊髓受压程度、影像学资料、骨化范围及患者全身情况合理选择恰当的手术入路是手术成功的关键。

Different surgical approachs for the treatment of severe cervical spondylotic myelopathy with ossification of posterior longitudinal ligament

Objective To explore the clinical outcome of the anterior approach and posterior-anterior approach surgical treatment for severe cervical spondylotic myelopathy with OPLL.Methods Totally 38 patients with severe cervical spondylotic myelopathy and continuous OPLL operated by anterior approach(Group A,22 cases) or posterior-anterior approach(Group B,16 cases) surgical treatment were retrospectively analyzed.The radiological date were compared between two groups by different approach,including spinal canal occupying rate,extent of OPLL and cord flattening rate.According to JOA score,preoperative score and postoperative follow-up score were compared,improvement rates were caleulated respectively.Result All cases were regularly followed up.The duration of follow-up averaged 20 months(ranged,12～30 months).The spinal function got improved in 38 patiens,and no severe complications such as cord or vertebral artery injury occurred.In group A,the preoperative mean scores of JOA was 7.9±2.1,and the postoperative JOA scores was 13.1±1.7(evaluated in 12 months after surgery),for anterior approach with the mean improvement ratio of(65.9±5.2)%.In group B,the preoperative mean scores of JOA was 6.8±1.6,and the postoperative JOA scores was 13.9±0.9(evaluated in 12 months after surgery),the mean improvement ratio of(69.8±4.5)%.The difference betreen two groups was not statistically significant(P>0.05).Conclusion The appropriate approach surgical treatment for severe cervical spondylotic myelopathy with OPLL can provide a satisfied result.Its important to select a suitable surgical approach according to the severity of compressed spinal cord、the imaging manifestations and the general conditions of the patients.