CAJ | 학술논문

目的观察“单开门”揭开式椎板整块切除、椎弓根螺钉固定治疗极重度颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)的临床疗效.方法回顾性分析2007年1月至2011年12月治疗极重度颈椎OPLL 16例患者资料,男13例,女3例；年龄45～74岁,平均56.5岁.15例神经功能损害与头颈部活动有关(如打喷嚏、咳嗽、过伸颈部等),1例诱因不明,神经症状均持续加重.术前日本矫形外科协会评分(Japanese Orthopaedic Score,JOA)为(7.1±1.8)分.术前CT扫描示骨化的后纵韧带平均占椎管矢状径的83.7％.患者均接受后路椎板整块切除、颈椎弓根螺钉固定手术.结果手术时间为80～150 min,平均130 min；出血量为150～600 ml,平均300ml.16例患者均获得随访,随访时间为3个月至4年,平均(24.4±10)个月,术后2周、3个月、末次随访平均JOA评分为(13.2±1.7)分、(13.5±1.6)分、(14.1±1.5)分,JOA评分改善率分别为61.6％、64.6％、70.7％.术后1例伤口形成血肿,1例发生脑脊液漏,3例肩背部疼痛.术中、术后未见深部感染、神经功能恶化、椎动脉损伤、内固定失败等严重并发症.结论颈椎“单开门”揭开式椎板整块切除术对脊髓干扰小、安全性高,结合颈椎弓根螺钉固定能够稳定减压节段,维持颈椎曲度,可用于重度颈椎OPLL合并颈脊髓损伤患者的治疗.
목적 관찰“단개문”게개식추판정괴절제、추궁근라정고정치료겁중도경추후종인대골화증(ossification of posterior longitudinal ligament,OPLL)적림상료효.방법 회고성분석2007년1월지2011년12월치료겁중도경추OPLL 16례환자자료,남13례,녀3례；년령45～74세,평균56.5세.15례신경공능손해여두경부활동유관(여타분체、해수、과신경부등),1례유인불명,신경증상균지속가중.술전일본교형외과협회평분(Japanese Orthopaedic Score,JOA)위(7.1±1.8)분.술전CT소묘시골화적후종인대평균점추관시상경적83.7％.환자균접수후로추판정괴절제、경추궁근라정고정수술.결과 수술시간위80～150 min,평균130 min；출혈량위150～600 ml,평균300ml.16례환자균획득수방,수방시간위3개월지4년,평균(24.4±10)개월,술후2주、3개월、말차수방평균JOA평분위(13.2±1.7)분、(13.5±1.6)분、(14.1±1.5)분,JOA평분개선솔분별위61.6％、64.6％、70.7％.술후1례상구형성혈종,1례발생뇌척액루,3례견배부동통.술중、술후미견심부감염、신경공능악화、추동맥손상、내고정실패등엄중병발증.결론 경추“단개문”게개식추판정괴절제술대척수간우소、안전성고,결합경추궁근라정고정능구은정감압절단,유지경추곡도,가용우중도경추OPLL합병경척수손상환자적치료.
Objective To evaluate the effect of en bloc open-door laminectomy and pedicle screw fixation for extremely severe cervical ossification of posterior longitudinal ligament (OPLL).Methods From January 2007 to December 2011,16 cases of serious cervical OPLL were treated,in which there were 13 males and 3 females,aged from 45 to 74 years (average,56.5 years).Spinal cord functional deterioration was related to minor activities of the neck,such as sneeze,cough or hyperextension of the neck,in 15 cases.One case suffered from aggravating neurological symptoms without a definite precipitating factor.The average preoperative Japanese Orthopaedic Score (JOA) was 7.1 ±1.8.Preoperative CT scans displayed the average stenotic rate (thickness of OPLL/sagittal diameter of the spinal canal) was 83.7％.All the patients received en bloc laminectomy and pedicle screw fixation of the cervical spine.Results All the patients were followed up for 3 months to 4 years (average,24.4±10 months).The JOA scores at 2 weeks,3 months,and the last follow-up postoperatively were 13.2±1.7,13.5 ±1.6 and 14.1 ±1.5,respectively; the improvement rates were 61.6％,64.6％ and 70.7％,respectively.The operative time ranged from 80 to 150 minutes (average,130 minutes),and blood loss ranged from 150 to 600 ml (range,300 ml).One case of postoperative wound hematoma,1 case of cerebrospinal fluid leakage and 3 cases of trapezius muscle pain occurred in this group.No serious complications,such as deep infection,deterioration of neurological dysfunction,vertebral artery injury and internal fixation failure,were noticed.Conclusion Owing to the minimum interference to the cervical spinal cord,stabilization of the decompressed segments and maintenance of cervical lordosis,en bloc open-door laminectomy and pedicle screw fixation is suitable for extremely severe cervical OPLL.