应用张力带式椎板成形术治疗颈椎后纵韧带骨化

摘要

目的 评价应用张力带式椎板成形术(TBL)治疗颈椎后纵韧带骨化(OPLL)的疗效.方法 本组病例包括颈椎后纵韧带骨化46例,男33例,女13例,平均年龄59岁(36～77岁).韧带骨化范围在C2-6,包括单节段型4例,连续型20例和混合型22例.全部病例均接受C2-7,TBL,受累节段涉及C3或以上者,同时接受寰椎后弓切除术.神经功能疗效评估采用日本骨科学会的颈椎病评分标准(JOA).解剖学疗效分析是利用计算机对手术前后X线片及MRI进行测量.结果 术后42例(91.3%)患者神经功能得到改善,影像学分析显示术后硬膜囊、脊髓中矢径增加和脊髓后移.结论 TBL手术是治疗颈椎OPLL的一种有效方法.%Objective To evaluate the effectiveness of Tension-band Laminoplasty (TBL) as a management for cervical ossification of posterior longitudinal ligament (OPLL).Methods Forty-six patients with cervical OPLL and undergone TBL in our department were chosen for the present study, including 33 male and 13 female.The mean age was 59 years (36-77 years).These OPLLs were confirmed as following types: 4 cases of single spinal level, 20 cases of continuous and 22 cases of mixed type.C3 or/and C2 levels were involved in 16 cases.All the patients underwent C2-7 TBL, to which C1 laminectomy was added for the cases with C3 and/or C2 involved.The neurological effect was evaluated by using Japanese Orthopedic Association (JOA) scoring criteria for cervical myelopathy.The anatomical effect was analyzed by comparing the pre- and post-operatively reentgenograms and MRIs.Wilcoxan's rank test was used for the statistics study.Results For 42(91.3% )patients, the JOA scores were improved for approximately 2 points after the operation, posterior shift of the spinal cord was obtained, while the diameters of dural sleeves and spinal cords were enlarged, yet the spinal alignments were not significantly interupted.Conclusions TBL was proved an effective treatment for cervical OPLL and it could be expanded to include C1 lamiuectomy if the spinal levels upper than C4 were involved.