选择性半椎板切除治疗颈椎后纵韧带骨化症

摘要

目的 分析选择性半椎板切除治疗颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)的手术技术、适应证、优缺点及临床疗效.方法回顾性研究146例使用此术式治疗的严重多节段颈椎OPLL患者.采用日本骨科学会(Japanese Orthopaedic Association,JOA)评分评价患者的神经功能.分析手术技术要点及治疗效果.结果 术后平均随访3.3年(1~4年).末次随访时患者的JOA评分平均为14.2,显著优于术前平均10.4分.JOA评分改善率平均为58.1%.颈椎前凸角术前平均为8.6°,末次随访时平均为9.0°,差异无统计学意义.所有患者术后未发现有C5神经根病的表现.结论 选择性半椎板切除联合单侧侧块螺钉内固定是治疗严重多节段颈椎OPLL的一种有效方法,由于最大限度保留了颈椎后部结构,降低了C5神经根病及后凸畸形的发生率.%Objective To retrospectively review the experience in treating patients who underwent selective hemilaminectomy for multilevel cervical ossification of posterior longitudinal ligament ( OPLL ), and to describe the technique with its indications, advantages and disadvantages. Methods A total of 146 patients suffered cervical OPLL and underwent multilevel hemilaminectomy with lateral mass fixation were retrospectively reviewed. Neurological condition was evaluated with the improvement ratio ( IR ) of the Japanese Orthopaedic Association( JOA ) score for cervical myelopathy. The decompression technique and surgical outcome were analyzed. Results The average of follow-up period was 3.3 ( 1-4 ) years. The study showed that the mean JOA score significantly increased from 10. 4 points before operation to 14. 2 points at the final follow-up ( P <0.01 ). The mean IR of neurological function ( JOA score ) was 58. 1% . Cervical lordosis changed from 8. 6°to 9. 0°at the final follow-up. C5 palsy was not observed of all patients after decompression. Conclusion Under appropriate conditions , selective hemilaminectomy is an alternative technique for OPLL. The incidence of C5 palsy and cervical kyphosis may decrease due to preserving more posterior spinal structures and restriction of spinal cord shift.