中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2012年
7期
590-595
,共6页
田伟%韩骁%刘波%吴静晔%马赛%张宁%郑山%于杰%冯学会%翁崇
田偉%韓驍%劉波%吳靜曄%馬賽%張寧%鄭山%于傑%馮學會%翁崇
전위%한효%류파%오정엽%마새%장저%정산%우걸%풍학회%옹숭
颈椎%骨化,后纵韧带%外科手术,选择性%体层摄影术,X线计算机
頸椎%骨化,後縱韌帶%外科手術,選擇性%體層攝影術,X線計算機
경추%골화,후종인대%외과수술,선택성%체층섭영술,X선계산궤
Cervical vertebrae%Ossification of posterior longitudinal ligament%Surgical procedures,elective%Tomography,X-ray computed
目的 应用矢状位重建CT明确颈椎后纵韧带骨化(OPLL)患者手术方式选择的策略.方法 选取2007年7月至2010年11月所有因OPLL进行手术治疗并获得超过1年随访的161例患者.其中男性106例,女性55例.手术时年龄26～77岁,平均54.5岁.随访时间12～54个月,平均28个月.40例患者接受颈椎前路手术(前路组).其中14例接受颈前路椎体次全切除减压植骨融合术,26例接受颈前路间盘切除减压内固定植骨融合术.120例患者接受颈椎后路棘突纵割式颈椎管扩大人工骨桥成形术(SLAC手术)(后路组).1例患者接受前后路联合手术.矢状位重建CT显示,前路组造成脊髓压迫的主要诊断为颈椎间盘突出,后路组为OPLL；前路组患者脊髓压迫的节段数量为1～2节,后路组患者脊髓压迫的节段数量为1～5节,以2～4节为主；前路组OPLL分型为节段型或局限型,以节段型为主；后路组各型的分布较为平均.后路手术患者应用改良K线的方法分组,并进行临床效果的比较.改良K线是矢状位重建CT上连接枢椎及C7椎管中点的连线.脊髓压迫未超过K线为阳性组,超过K线为阴性组.采用t检验、x2检验进行统计分析,并对矢状位CT颈椎整体曲度及中立位X线颈椎整体曲度进行相关性分析.结果 前路组患者末次随访的JOA改善率(72％±27％)较后路组(59％±35％)高,差异有统计学意义(t =2.238,P=0.027).后路组患者中,改良K线阳性患者末次随访时的JOA改善率(63％±37％)高于阴性的患者(49％±30％),差异有统计学意义(t=2.150,P=0.034).矢状位CT颈椎整体曲度为11°±9°与中立位X线颈椎整体曲度10°±10°相比较差异无统计学意义(P＞0.05),并有较强的相关性(r=0.947,P＜0.01).结论OPLL手术方式的选择,需应用矢状位重建CT,结合脊髓压迫的主要诊断、压迫的节段及范围、OPLL 分型、是否后凸等因素综合考虑.改良K线是预测颈椎后路椎管扩大成形术减压效果的有效评价指标.
目的 應用矢狀位重建CT明確頸椎後縱韌帶骨化(OPLL)患者手術方式選擇的策略.方法 選取2007年7月至2010年11月所有因OPLL進行手術治療併穫得超過1年隨訪的161例患者.其中男性106例,女性55例.手術時年齡26～77歲,平均54.5歲.隨訪時間12～54箇月,平均28箇月.40例患者接受頸椎前路手術(前路組).其中14例接受頸前路椎體次全切除減壓植骨融閤術,26例接受頸前路間盤切除減壓內固定植骨融閤術.120例患者接受頸椎後路棘突縱割式頸椎管擴大人工骨橋成形術(SLAC手術)(後路組).1例患者接受前後路聯閤手術.矢狀位重建CT顯示,前路組造成脊髓壓迫的主要診斷為頸椎間盤突齣,後路組為OPLL；前路組患者脊髓壓迫的節段數量為1～2節,後路組患者脊髓壓迫的節段數量為1～5節,以2～4節為主；前路組OPLL分型為節段型或跼限型,以節段型為主；後路組各型的分佈較為平均.後路手術患者應用改良K線的方法分組,併進行臨床效果的比較.改良K線是矢狀位重建CT上連接樞椎及C7椎管中點的連線.脊髓壓迫未超過K線為暘性組,超過K線為陰性組.採用t檢驗、x2檢驗進行統計分析,併對矢狀位CT頸椎整體麯度及中立位X線頸椎整體麯度進行相關性分析.結果 前路組患者末次隨訪的JOA改善率(72％±27％)較後路組(59％±35％)高,差異有統計學意義(t =2.238,P=0.027).後路組患者中,改良K線暘性患者末次隨訪時的JOA改善率(63％±37％)高于陰性的患者(49％±30％),差異有統計學意義(t=2.150,P=0.034).矢狀位CT頸椎整體麯度為11°±9°與中立位X線頸椎整體麯度10°±10°相比較差異無統計學意義(P＞0.05),併有較彊的相關性(r=0.947,P＜0.01).結論OPLL手術方式的選擇,需應用矢狀位重建CT,結閤脊髓壓迫的主要診斷、壓迫的節段及範圍、OPLL 分型、是否後凸等因素綜閤攷慮.改良K線是預測頸椎後路椎管擴大成形術減壓效果的有效評價指標.
목적 응용시상위중건CT명학경추후종인대골화(OPLL)환자수술방식선택적책략.방법 선취2007년7월지2010년11월소유인OPLL진행수술치료병획득초과1년수방적161례환자.기중남성106례,녀성55례.수술시년령26～77세,평균54.5세.수방시간12～54개월,평균28개월.40례환자접수경추전로수술(전로조).기중14례접수경전로추체차전절제감압식골융합술,26례접수경전로간반절제감압내고정식골융합술.120례환자접수경추후로극돌종할식경추관확대인공골교성형술(SLAC수술)(후로조).1례환자접수전후로연합수술.시상위중건CT현시,전로조조성척수압박적주요진단위경추간반돌출,후로조위OPLL；전로조환자척수압박적절단수량위1～2절,후로조환자척수압박적절단수량위1～5절,이2～4절위주；전로조OPLL분형위절단형혹국한형,이절단형위주；후로조각형적분포교위평균.후로수술환자응용개량K선적방법분조,병진행림상효과적비교.개량K선시시상위중건CT상련접추추급C7추관중점적련선.척수압박미초과K선위양성조,초과K선위음성조.채용t검험、x2검험진행통계분석,병대시상위CT경추정체곡도급중립위X선경추정체곡도진행상관성분석.결과 전로조환자말차수방적JOA개선솔(72％±27％)교후로조(59％±35％)고,차이유통계학의의(t =2.238,P=0.027).후로조환자중,개량K선양성환자말차수방시적JOA개선솔(63％±37％)고우음성적환자(49％±30％),차이유통계학의의(t=2.150,P=0.034).시상위CT경추정체곡도위11°±9°여중립위X선경추정체곡도10°±10°상비교차이무통계학의의(P＞0.05),병유교강적상관성(r=0.947,P＜0.01).결론OPLL수술방식적선택,수응용시상위중건CT,결합척수압박적주요진단、압박적절단급범위、OPLL 분형、시부후철등인소종합고필.개량K선시예측경추후로추관확대성형술감압효과적유효평개지표.
Objective Use sagittal reconstruction CT to verify the surgical strategy for cervical ossification of the posterior longitudinal ligament (OPLL).Methods A retrospective study of 161 patients (106 males and 55 females) who had undergone surgery for OPLL from July 2007 to November 2010 was performed.The mean age at surgery was 54.5 years ( range from 26 to 77 years).The mean follow-up period was 28 months (12-54 months).There were 40 patients accept anterior approach surgeries (anterior group)which include 14 cases of anterior cervical corpectomy and fusion and 26 cases of anterior cervical discectomy and fusion.There were 120 patients accept posterior approach surgeries (posterior group) which was spinous process-splitting laminoplasty for cervical myelopathy using coralline hydroxyapatite,One patient accepted combined anterior and posterior approach.According to the sagittal reconstruction CT,the main reason for spinal cord compression was cervical disc herniation in anterior group,and OPLL in posterior group.The level of spinal cord compression was 1 to 2 levels in anterior group,and 1 to 5 levels in posterior group with a major of 2 to4 levels.As the classification of OPLL,segmentsl type and circumscribed type were major of segmental type in anterior group and all of the four types were in posterior group,the distribution of each type was average.The patients of posterior group were classified into two groups according to the modified K-line classification,and clinical results were compared between the two groups.The modified K-line was defined as a line that connects the midpoints of the spinal canal at C2 and C7 on sagittal CT myelography.Compression to the spinal cord did not exceed the K-line in the modified K-line ( + ) group and did exceed it in the modified K-line ( - ) group.Clinical data were compared using t-test or x2 test.Correlation analysis was used to determine the relationships of C2-C7 angulation between sagittal reconstruction CT and neutral position X-ray.Results The patient of anterior group had better recovery rate of the JOA score (72％ ±27％ ) than the posterior group (59％ ± 35％ ) at the latest follow-up (t =2.238,P=0.027).In posterior group,the patients of modified K-line ( + ) group had better recovery rate of the JOA score (63％ ±37％ ) than the K-line ( - ) group (49％ ±30％ ) at the latest follow up (t =2.150,P=0.034).The C2-C7 angulation on sagittal reconstruction CT was 11°± 9° which has significandy correlated with the C2-C7 angulation on neutral position X-ray which was 10°±10°( r =0.947,P＜ 0.01 ).Conclusions Considering the selection of surgical approach,it should be combined with the main clinical diagnosis for spinal cord compression,the level of compression,the classification of OPLL and the kyphotic alignment of the cervical spine.The modified K-line is a simple and practical tool for making decisions regarding the surgical strategy for cervical OPLL patients.
