李阳;袁文;张颖;王新伟;周许辉;陈华江;

• 1:第二军医大学长征医院骨科

摘要(Abstract)：

[目的]观察伴脊髓高信号(high-signal intensity zone,HIZ)改变的颈椎后纵韧带骨化症(ossification ofthe posterior longitudinal ligament,OPLL)手术疗效结果,分析影响疗效的因素,为临床治疗选择提供依据。[方法]随访自2005年3月~2008年3月诊治于上海长征医院骨科的40例伴有脊髓HIZ改变的OPLL患者,其中19例行经前路手术为A组,21例行颈后路手术为P组。术前及术后末次随访时行JOA17评分法进行评分,分析比较术前术后评分并计算比较分析改善率。[结果]A组平均随访时间(19.5±3.4)个月,P组平均随访时间(20.3±4.5)个月,术后随访时间无统计学差异。A组术后JOA评分(12.8±0.9)分,P组(11.5±1.6)分,差异具有统计学意义。手术治疗改善率A组为(56.2±8.4)%,P组(52.5±12.2)%,差异不具有统计学意义。脊髓HIZ改变区域术后无一例完全消失,但范围均有一定程度减小。[结论]伴有HIZ改变的OPLL手术风险大,神经功能恢复有限,但是根据术者的经验、骨化组织类型、位置以及椎管狭窄率选择正确的前路或者后路手术方式均可达到良好的效果。

关键词(KeyWords)： 颈椎;后纵韧带骨化;脊髓高信号;减压;内固定

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 李阳;袁文;张颖;王新伟;周许辉;陈华江;

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DOI:

参考文献(References)：

• [1]Kawano H,Handa Y,Ishii H,et al.Surgical treatment for ossificationof the posterior longitudina1 ligament of the cervicaI spine[J].J Spi-naI Disord,1995,8:145-150.
• [2]Mizuno J,Nakagawa H.Anterior decompression for cervical spondylosisassociated with an early form of cervical ossification of the posteriorlongitudinal ligament[J].Neurosurg Focus,2002,12:12.
• [3]陈德玉,陈宇,王新伟,等.颈椎后纵韧带骨化症的手术治疗及疗效分析[J].中国矫形外科杂志,2006,1:9-11.
• [4]Hirabayas K,Toyama Y,Chiba K.Expansive laminoplasty for myelopa-thy in ossification of the longtudinal ligament[J].Clini Orthop RelatRes,1999,359:35-48.
• [5]Tateiwa Y,Kamimura M,Hoh H,et al.Multilevel subtotal corpectomyand interbody fusion for cervical myelopathy due to ossification of theposterior longitudinal ligament[J].J Clin Neurosci,2003,10:199-207.
• [6]Houten JK,Coper PR.Laminectomy and posterior cervical plating formultilevel cervical spondylotic myelopathy and ossification of the poste-rior longitudinal ligament:effects on cervical alignment,spinal cordcompression,and neurological outcome[J].Ncurosurgery,2003,52:l081-1087.
• [7]Morio Y,Teshima R,Nagashima H,et al.Correlation between opera-tive outcomes of cervical compression mylopathy and meri of the spine[J].Spine,2001,26:1238-1245.
• [8]陈德玉.颈椎伤病诊治新技术[M].上海:科学技术文献出版社,2003,231-232.
• [9]Epstein NE.Circumferential cervical surgery for ossification of the pos-terior longitudinal ligament:a multianalytic outcome study[J].Spine,2004,29:1340-1345.
• [10]李永军,于俊叶,张宇晨,等.后前路联合手术治疗重型颈椎后纵韧带骨化症[J].中国脊柱脊髓杂志,2008,18:103-107.
• [11]倪文飞,林焱,池永龙,等.脊柱前路手术并发硬膜损伤的原因与治疗[J].中国骨与关节损伤,2006,5:370-371.
• [12]田纪伟,王雷,董双海,等.颈椎后纵韧带骨化症手术并发症探讨[J].中国矫形外科杂志,2007,15:1139-1142.
• [13]Hironobu S,Noboru H,Yoshihiro M,et al.C5palsy after decompres-sion surgery for cervical myelopathy[J].Spine,2001,21:2447-2451.
• [14]Ogawa Y,Toyama Y,Chiba K,et al.Long-term results of expansiveopen-door laminoplasty for ossification of file posterior longitudinalligament of the cervical spine[J].J Neurosurg Spine,2004,17:168-174.