颈椎后纵韧带骨化症的外科治疗方式﹡

目的研究不同类型颈椎后纵韧带骨化症﹙OPLL﹚的手术治疗方式及疗效分析。方法统计2007年~2009年治疗的颈椎OPLL患者64例,分别采用后路椎板单开门减压成形术、前路减压植骨融合内固定术及前后路联合减压手术治疗,统计术前术后JOA评分并计算神经功能改善率,评估疗效。结果后路手术44例,术前JOA评分7~12分,平均9.2±1.3分,术后1年JOA评分10~16分,平均13.6±1.5分,神经功能改善率16.7%~87.5%,平均﹙55.7±18.7﹚%;前路手术14例,术前JOA评分8~11分,平均8.9±0.9分,术后1年JOA评分12~15分,平均14.1±0.8分,神经功能改善率44.4%~77.8%,平均﹙63.4±10.0﹚%;前后联合手术6例,术前JOA评分7~10分,平均8.0±1.1分,术后1年JOA评分13~14分,平均13.5±0.5分,神经功能改善率55.6%~70.0%,平均﹙60.8±6.1﹚%。前路手术组术前症状较后路手术组重,手术难度更大,但术后神经功能恢复更好。结论根据颈椎OPLL的类型、部位、椎管压缩率、年龄选择合适的手术方式,能够取得更好的治疗效果,减少并发症发生。

Surgical treatment of cervical ossification of posterior longitudinal ligament

Objective To evaluate 3 kinds of operative method in cervical ossification of posterior longitudinal ligament ﹙OPLL﹚andassesstheeffects.Methods64cervicalOPLLpatientswhoweretreatedwithposterioropen-doorlaminoplasty,anterior decompression,or posterior-anterior approach respectively from 2007 to 2009 were reviewed retrospectively.The final effects were assessed by preoperative and postoperative JOA scores and the improvement rates..Results The average preoperative JOA scores of posterior,anterior and posterior-anterior approach were 9.2±1.3、8.9±0.9and 8.0±1.1.The average postoperative JOA scores were 13.6±1.5、14.1±0.8 and 13.5±0.5.The average improvement rates were﹙55.7±18.7﹚ %、﹙63.4±10.0﹚% and﹙60.8±6.1﹚%.The anterior approach was more difficult than the posterior approach,and the preoperative JOA scores of anterior approach group were lower but the improvement rates were higher than those of posterior group.Conclusion Choosing correct operative approach by the OPLL′s type,location and the compression level can improve the clinical effect and decrease the complication.