前路椎体骨化物复合体前移融合术治疗颈椎后纵韧带骨化症

摘要

目的 评估颈椎前路椎体骨化物复合体前移融合术(ACAF)对颈椎后纵韧带骨化症(OPLL)椎管横截面积及椎管矢状径的改善情况. 方法 2017年5月—2017年8月,本院采用ACAF治疗颈椎OPLL患者13例,术前、术后采用日本骨科学会(JOA)评分评估患者神经功能情况,采用视觉模拟量表(VAS)评分评估患者疼痛程度;术前、术后在颈椎侧位X线片上测量颈椎椎管矢状径,在横断面CT上测量骨化物横截面积和椎管横截面积,并计算椎管狭窄率. 结果 所有患者手术顺利完成.所有患者随访3 ~ 6个月,神经功能均得到不同程度恢复.末次随访时,JOA和VAS评分均较术前有所改善,椎管矢状径和椎管横截面积均较术前增加,椎管狭窄率较术前降低,差异均有统计学意义(P < 0.05). 结论 ACAF治疗颈椎OPLL安全有效,可扩大椎管矢状径,增大椎管横截面积,降低椎管狭窄率,使患者神经症状明显改善,短期疗效满意.%Objective To evaluate the surgical outcomes of anterior controllable anteriodisplacement and fusion(ACAF) for ossification of posterior longitudinal ligament(OPLL). Methods From May 2017 to August 2017,13 OPLL patients underwent ACAF. The Japanese Orthopaedic Association(JOA) and visual analogue scale(VAS) score were used to evaluate pre- and post-operative neurological function and pain. The pre- and post-operative sagittal canal diameter were measured on the lateral roentgenograph. The pre- and post-operative maximum thickness of ossification,the maximum stenosis rate of the vertebral canal and the cross-sectional area of the vertebral canal were measured on the cross-sectional CT. Results All the operations were completed successfully. All the patients were followed up for 3 - 6 months,and the neurological function was recovered to varying degrees. At the final follow-up,the JOA and VAS scores were both improved compared with those before operation;the cross-sectional area and sagittal diameter of the vertebral canal were both higher than those before operation;the spinal stenosis rate was lower than that before the operation;the differences were statistically significant(P < 0.05). Conclusion ACAF is safe and effective for cervical OPLL and can expand sagittal diameter of vertebral canal,decrease spinal canal stenosis rate and increase cross sectional area of spinal canal,so that neurological symptoms can be obviously improved and short-term therapeutic effect is satisfactory.