改良法单开门椎管扩大椎板成形术治疗颈椎后纵韧带骨化症合并颈椎不稳的疗效评价

摘要

目的 评估改良法单开门椎管扩大椎板成形术治疗多节段颈椎后纵韧带骨化症(OPLL)合并颈椎不稳的临床疗效. 方法 回顾性分析2011年1月—2015年8月使用改良法单开门椎管扩大椎板成形术治疗的多节段颈椎OPLL合并颈椎不稳的32例患者的临床资料.记录患者的手术时间、术中出血量、并发症发生情况;分析比较术前及随访时的颈椎日本骨科学会(JOA)评分和颈肩部疼痛视觉模拟量表(VAS)评分、颈椎Cobb角及颈椎活动度(ROM),术后1周及随访时的椎板开门角度. 结果 所有患者手术顺利,随访20 ~ 63个月,手术时间(135±48)min,术中出血量(322±82)mL.末次随访时,患者JOA和VAS评分均较术前显著改善,差异均有统计学意义(P < 0.05).末次随访时颈椎Cobb角与术前相比差异无统计学意义(P > 0.05).末次随访时颈椎ROM较术前减小,差异有统计学意义(P <0.05).术后1周颈椎开门角度与末次随访时相比差异无统计学意义(P > 0.05). 结论 改良法单开门椎管扩大椎板成形术治疗多节段OPLL合并颈椎不稳能获得有效减压、提高神经功能的效果,同时能较好地维持椎板开门角度.%Objective To evaluate the clinical outcome of a modified open-door laminoplasty for multi-level ossification of posterior longitudinal ligament(OPLL) associated with cervical instability. Methods From January 2011 to August 2015,32 multi-level OPLL patients associated with cervical instability were included in the study. All the patients underwent a modified open door laminoplasty with lateral mass screw fixation. The operation time,intraoperative blood loss and complications were recorded. The pre- and post-operative Japanese Orthopedic Association(JOA) score,pre- and post-operative neck and arm pain visual analogue scale(VAS) score,postoperative lamina open angle,cervical Cobb's angle,and cervical range of motion(ROM) were recorded and analyzed. Results All the patients underwent successful surgeries. The follow-up time was 20 - 63 months. The operation time was (135±48)min,and blood loss was (322±82)mL. At the final follow-up,the JOA and VAS scores of the patients were significantly improved than those before the operation,and the differences were statistically significant (P < 0.05). There was no statistically significant difference in the Cobb's angle between the pre-operation and final follow-up (P > 0.05). At the final follow-up,the cervical ROM decreased compared with preoperative,and the difference was statistically significant(P < 0.05). No significant difference was found in open angles between post-operative 1 week and final follow-up (P > 0.05). Conclusion The modified open door laminoplasty for multi-level OPLL combined with cervical instability can achieve effective decompression,improve neurological function,and maintain lamina open angle.