一期前后联合手术与单纯后路手术治疗重度颈椎后纵韧带骨化症临床疗效的差异分析Comparison of clinic outcome of severe cervical ossification of the posterior longitudinal ligament (OPLL) between laminoplasty and posterior laminoplasty (or laminotomy) combined with anterior decompression and fusion
王贤;韦敏克;梁斌;尹东;陈峰;丘德赞;韦建勋;
摘要(Abstract):
[目的]比较前后路联合手术与单纯后路手术治疗重度颈椎后纵韧带骨化症临床疗效及影像学改变的差异,探讨重度颈椎后纵韧带骨化症手术方式的选择策略。[方法]38例资料完整的重度颈椎后纵韧带骨化患者,接受前后路联合手术13例,接受单纯后路手术25例。记录两组术后并发症,并对两组术后颈椎曲度Cobb角变化及JOA评分改善率进行比较;根据Fujiyoshi介绍的K线法对所有患者进行分类,分别比较在K线阳性和K线阴性组患者两种手术策略疗效的差异。[结果]单纯后路手术组中出现椎管内血肿1例,浅表感染1例,C5神经根麻痹2例;前后联合手术组中脑脊液漏3例,喉返神经损伤1例;后前路联合手术组颈椎Cobb角由术前平均7.1°增加至末次随访时的11.3°,单纯后路手术组颈椎Cobb角由术前的平均7.3°至末次随访时的平均3.7°,两组颈椎Cobb角变化有显著性差异(P<0.05);两组患者手术前后JOA评分及改善率均无显著性差异(P>0.05),K线阴性患者中后前联合入路手术组JOA评分改善率显著高于单纯后路手术组。[结论]后前路联合手术与单纯后路手术治疗重度颈椎后纵韧带骨化症总体临床疗效无显著差异;后前路联合手术能够更好的恢复颈椎曲度;K线是重度颈椎后纵韧带骨化症手术策略选择的重要指标。
关键词(KeyWords): 颈椎;后纵韧带骨化;K线
基金项目(Foundation):
作者(Author): 王贤;韦敏克;梁斌;尹东;陈峰;丘德赞;韦建勋;
Email:
DOI:
参考文献(References):
- [1]Fujiyoshi T,Yamazaki M,Kawabe J,et al.A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament the k-line[J].Spine,2008,26:990-993.
- [2]Chen Y,Guo YF,Chen DY,et al.Long-term outcome of laminectomy and instrumented fusion for cervical ossification of the posterior longitudinal ligament[J].Int Orthop,2009,33:1075-1080.
- [3]Chen Y,Chen DY,Wang XW,et al.Anterior corpectomy and fusion for severe ossification of posterior longitudinal ligament in the cervical spine[J].Int Orthop,2009,33:477-482.
- [4]杨大龙,曹俊明,申勇,等.后前路联合分期手术治疗颈椎后纵韧带骨化症伴发育性椎管狭窄[J].中国矫形外科杂志,2010,19:1585-1587.
- [5]Iwasaki M,Okuda SY,Miyauchi A,et al.Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament.Part 1:clinical results and limitations of laminoplasty[J].Spine,2007,6:647-653.
- [6]Chen Y,Guo YF,Chen DY,et al.Diagnosis and surgery of ossification of posterior longitudinal ligament associated with dural ossification in the cervical spine[J].Eur Spine J,2009,18:1541-1547.
- [7]Chiba K,Ogawa Y,Ishii K,et al.Long-term results of expansive open-door laminoplasty for cervical myelopathy-average 14-year follow-up study[J].Spine,2006,31:2998-3005.
- [8]Edwards C,Heller JG,Murakami H,et al.Corpectomy versus laminoplasty for multilevel cervical myelopathy:an independent matched-cohort analysis[J].Spine,2002,27:1168-1175.
- [9]Epstein N.Anterior approaches to cervical spondylosis and ossification of the posterior longitudinal ligament:review of operative technique and assessment of 65 multilevel circumferential procedures[J].Surg Neurol,2001,55:313-324.
- [10]Cardoso MJ,Koski TR,Ganju A,et al.Approach-related complications after decompression for cervical ossification of the posterior longitudinal ligament[J].Neurosurg Focus,2011,3:1-5.
- [11]Hannallah D,Lee J,Khan M,et al.Cerebrospinal fluid leaks following cervical spine surgery[J].J Bone Joint Surg Am,2008,5:1101-1105.
- [12]Joseph V,Kumar GS,Rajshekhar V.Cerebrospinal fluid leak during cervical corpectomy for ossified posterior longitudinal ligament:incidence,management,and outcome[J].Spine,2009,34:491-494.
- [13]Matsuoka T,Yamaura I,Kurosa Y et al,Long-term results of the anterior floating method for cervical myelopathy caused by ossification of the posterior longitudinal ligament[J].Spine,2001,26:241-248.
- [14]Wang XW,Chen DY,Yuan W.Anterior surgery in selective patients with massive ossification of posterior longitudinal ligament of cervical spine:technical note[J].Eur Spine J,2012,2:314-321.
- [15]陈超,王岩,张雪松,等.K线用于选择颈椎后纵韧带骨化症手术策略的回顾性分析[J].中国脊柱脊髓杂志,2009,11:836-839.