寰枢椎脱位合并颈椎后纵韧带骨化症的手术疗效分析

目的探讨寰枢椎脱位合并颈椎后纵韧带骨化症(OPLL)的手术疗效。方法 2012年5月—2015年10月共收治寰枢椎脱位合并颈椎OPLL患者10例,其中易复型寰枢椎脱位8例,采用后路寰枢椎固定融合并颈椎单开门椎板成形术治疗;不可复型寰枢椎脱位2例,采用经口前路松解复位、后路枕颈融合并颈椎单开门椎板成形术治疗。采用日本骨科学会(JOA)评分及其改善率评估临床疗效,采用C2~7 Cobb角、颈椎活动度(ROM)、脊髓有效空间(SAC)和椎管狭窄率等评估影像学疗效。结果所有手术顺利完成。10例患者术后随访18~42个月,平均27.3个月。术后和末次随访时颈椎JOA评分较术前明显增加,其中JOA改善率优5例,良3例,可2例,优良率为80.0%。术后及末次随访时,颈椎Cobb角及ROM下降。术后SAC较术前明显增加,椎管狭窄率较术前明显降低。术中、术后无严重并发症发生,1例患者发生术后C5神经根麻痹,1例患者发生术后切口感染,经非手术治疗均痊愈。随访过程中无颈椎不稳、内固定松动或断钉现象发生,末次随访时所有患者均获得骨性融合。结论寰枢椎脱位合并颈椎OPLL手术治疗近期疗效确切,并发症发生率低。

Surgical effcacy analysis of atlantoaxial dislocation combined with cervical ossifcation of posterior longitudinal ligament

Objective To explore the surgical effect of atlantoaxial dislocation combined with cervical ossification of posterior longitudinal ligament(OPLL). Methods From May 2012 to October 2015, the clinical data of 10 atlantoaxial dislocation combined with cervical OPLL patients were analyzed retrospectively. Eight patients were categorized as reducible atlantoaxial dislocation underwent posterior atlantoaxial fixation and fusion with expansive open-door laminoplasty. Two patients were categorized as irreducible atlantoaxial dislocation underwent transoral anterior decompression and posterior occipitocervical fusion with expansive open-door laminoplasty. The Japanese Orthopaedic Association(JOA) score and its improvement rate were used to evaluate the clinical efficacy, C_2-7 Cobb''s angle, rage of motion(ROM) and space available for the cord(SAC) at the narrowest level were used to assess the imaging results. Results All the operations were completed successfully. All the patients were followed up for 18-42(mean 27.3) months. The JOA scores significantly increased at post-operation and the final follow-up. The improvement rate of JOA scores was excellent in 5 cases, good in 3 and fair in 2, and the effectiveness(excellent and good) rate was 80.0%. At the post-operation and the final follow-up, the cervical Cobb''s angle and ROM were decreased. At the post-operation, the SAC at the narrowest level significantly increased, and the spinal stenosis rate significantly decreased. There were no serious complications during or after the operation. There was 1 patient with postoperative C₅ nerve root palsy and 1 with postoperative incision infection. Both the patients were cured by conservative treatment. Bone fusion was achieved in all the patients, and there was no complication related to cervical instability, internal fixation breakage and loosening during the follow-up. Conclusion The surgical treatment of atlantoaxial dislocation combined with OPLL is effective in the short-term, with a low rate of surgery-related complications.